Provider Demographics
NPI:1922148667
Name:AURORA MEDICAL LLC
Entity Type:Organization
Organization Name:AURORA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AURORA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDREESCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-342-4008
Mailing Address - Street 1:130 OVERLOOK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2205
Mailing Address - Country:US
Mailing Address - Phone:201-342-4008
Mailing Address - Fax:201-342-4228
Practice Address - Street 1:130 OVERLOOK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2205
Practice Address - Country:US
Practice Address - Phone:201-342-4008
Practice Address - Fax:201-342-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62482207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HEALTHNETOther2K2256
OXFORDOtherP880048
EMPIREOther53S971
HEALTHNETOther2K2256
NJAN692120Medicare ID - Type Unspecified