Provider Demographics
NPI:1821300864
Name:CANTERBURY MEDICAL ASSOCIATES-CRITICAL CARE PC
Entity Type:Organization
Organization Name:CANTERBURY MEDICAL ASSOCIATES-CRITICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JERZY
Authorized Official - Middle Name:A
Authorized Official - Last Name:POPKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-795-8637
Mailing Address - Street 1:176 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1121
Mailing Address - Country:US
Mailing Address - Phone:201-795-8389
Mailing Address - Fax:
Practice Address - Street 1:176 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1121
Practice Address - Country:US
Practice Address - Phone:201-795-8389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty