Provider Demographics
NPI:1821770488
Name:LIN HEALTH MEDICAL GROUP OF NEW JERSEY
Entity Type:Organization
Organization Name:LIN HEALTH MEDICAL GROUP OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-523-8814
Mailing Address - Street 1:3513 BRIGHTON BLVD STE 457
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 EISENHOWER PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1054
Practice Address - Country:US
Practice Address - Phone:862-298-5516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty