Provider Demographics
NPI:1295137685
Name:EMERGENCY PHYSICIAN SERVICES OF NEW JERSEY PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:EMERGENCY PHYSICIAN SERVICES OF NEW JERSEY PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:TRACCI
Authorized Official - Last Name:MOUGANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-686-4394
Mailing Address - Street 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:856-686-4304
Mailing Address - Fax:865-560-7078
Practice Address - Street 1:718 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4245
Practice Address - Country:US
Practice Address - Phone:856-686-4304
Practice Address - Fax:865-560-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty