Provider Demographics
NPI:1700110368
Name:NORTH JERSEY MEDICAL ASSOC, LLC
Entity type:Organization
Organization Name:NORTH JERSEY MEDICAL ASSOC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:NICOSIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-694-2222
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:PEQUANNOCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07440-0370
Mailing Address - Country:US
Mailing Address - Phone:973-694-2222
Mailing Address - Fax:973-694-5184
Practice Address - Street 1:330 RATZER RD
Practice Address - Street 2:STE 13
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7702
Practice Address - Country:US
Practice Address - Phone:973-694-0000
Practice Address - Fax:973-694-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03341200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty