Provider Demographics
NPI:1720463813
Name:WALDWICK URGENT CARE LLC
Entity Type:Organization
Organization Name:WALDWICK URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GINNOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-686-2777
Mailing Address - Street 1:71 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:WALDWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:07463-1319
Mailing Address - Country:US
Mailing Address - Phone:201-445-1700
Mailing Address - Fax:
Practice Address - Street 1:71 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1319
Practice Address - Country:US
Practice Address - Phone:201-445-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty