Provider Demographics
NPI:1184987349
Name:NJY MEDICAL LLC
Entity type:Organization
Organization Name:NJY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:COCUZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-782-6444
Mailing Address - Street 1:680 BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-1524
Mailing Address - Country:US
Mailing Address - Phone:973-782-6444
Mailing Address - Fax:973-782-6445
Practice Address - Street 1:680 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-1524
Practice Address - Country:US
Practice Address - Phone:973-782-6444
Practice Address - Fax:973-782-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ243796Medicare PIN