Provider Demographics
NPI:1942398623
Name:THORACIC MEDICAL ASSOCIATES, LLC.
Entity Type:Organization
Organization Name:THORACIC MEDICAL ASSOCIATES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-997-0808
Mailing Address - Street 1:221 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2437
Mailing Address - Country:US
Mailing Address - Phone:201-997-0808
Mailing Address - Fax:201-997-0013
Practice Address - Street 1:221 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2437
Practice Address - Country:US
Practice Address - Phone:201-997-0808
Practice Address - Fax:201-997-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA057263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5560403Medicaid
NJ5560403Medicaid
NJ068976Medicare ID - Type UnspecifiedGROUP MEDICARE ID#