Provider Demographics
NPI:1891122792
Name:PASSAIC MEDICAL GROUP PA
Entity Type:Organization
Organization Name:PASSAIC MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VALSKYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-692-9631
Mailing Address - Street 1:87 BERDAN AVE
Mailing Address - Street 2:2B
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3210
Mailing Address - Country:US
Mailing Address - Phone:973-692-9631
Mailing Address - Fax:973-692-1112
Practice Address - Street 1:87 BERDAN AVE
Practice Address - Street 2:2B
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3210
Practice Address - Country:US
Practice Address - Phone:973-692-9631
Practice Address - Fax:973-692-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08186700207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty