Provider Demographics
NPI:1295449007
Name:NEXTGENUC LLC
Entity type:Organization
Organization Name:NEXTGENUC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:LADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-974-7279
Mailing Address - Street 1:481 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-4313
Mailing Address - Country:US
Mailing Address - Phone:201-875-2454
Mailing Address - Fax:732-707-5001
Practice Address - Street 1:481 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4313
Practice Address - Country:US
Practice Address - Phone:201-875-2454
Practice Address - Fax:732-707-5001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXTGENUC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty