Provider Demographics
NPI:1891219226
Name:MY DOC JERSEY URGENT CARE LLC
Entity Type:Organization
Organization Name:MY DOC JERSEY URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-295-3501
Mailing Address - Street 1:210 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-1355
Mailing Address - Country:US
Mailing Address - Phone:862-295-3501
Mailing Address - Fax:
Practice Address - Street 1:210 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1355
Practice Address - Country:US
Practice Address - Phone:862-295-3501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care