Provider Demographics
NPI:1952487548
Name:JERSEY FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:JERSEY FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LABIB
Authorized Official - Middle Name:
Authorized Official - Last Name:LABIB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-963-9055
Mailing Address - Street 1:142 PALISADE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1133
Mailing Address - Country:US
Mailing Address - Phone:201-963-9055
Mailing Address - Fax:201-963-9056
Practice Address - Street 1:142 PALISADE AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1133
Practice Address - Country:US
Practice Address - Phone:201-963-9055
Practice Address - Fax:201-963-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
NJMB66614261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center