Provider Demographics
NPI:1962828277
Name:NEW JERSEY MEDICAL SERVICES GROUP, LLC
Entity Type:Organization
Organization Name:NEW JERSEY MEDICAL SERVICES GROUP, LLC
Other - Org Name:NEW JERSEY GROUP, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-855-5355
Mailing Address - Street 1:7125 ORCHARD LAKE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3627
Mailing Address - Country:US
Mailing Address - Phone:248-855-5355
Mailing Address - Fax:248-855-5455
Practice Address - Street 1:83 HANOVER RD
Practice Address - Street 2:SUITE 260
Practice Address - City:FLORHAM
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-966-1040
Practice Address - Fax:973-966-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty