Provider Demographics
NPI:1942525290
Name:NORTH JERSEY LAPROSCOPIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTH JERSEY LAPROSCOPIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAIMAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-227-8326
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-0175
Mailing Address - Country:US
Mailing Address - Phone:201-227-8326
Mailing Address - Fax:201-396-2234
Practice Address - Street 1:222 CEDAR LN STE 201
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4312
Practice Address - Country:US
Practice Address - Phone:201-530-1900
Practice Address - Fax:201-530-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPENDMedicare PIN