Provider Demographics
NPI:1700126299
Name:NJ MEDICAL PROFESSIONALS LLC
Entity Type:Organization
Organization Name:NJ MEDICAL PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-336-1200
Mailing Address - Street 1:1020 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2244
Mailing Address - Country:US
Mailing Address - Phone:862-336-1200
Mailing Address - Fax:
Practice Address - Street 1:1020 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2244
Practice Address - Country:US
Practice Address - Phone:862-336-1202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09222300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0343251Medicaid