Provider Demographics
NPI:1912196908
Name:NORTHERN JERSEY LLC
Entity Type:Organization
Organization Name:NORTHERN JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-983-7337
Mailing Address - Street 1:797 THOMAS LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3903
Mailing Address - Country:US
Mailing Address - Phone:856-983-7337
Mailing Address - Fax:
Practice Address - Street 1:797 THOMAS LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3903
Practice Address - Country:US
Practice Address - Phone:856-983-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0600101241261QL0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy