Provider Demographics
NPI:1811453731
Name:PHYSICIANS ALLIANCE LLC
Entity type:Organization
Organization Name:PHYSICIANS ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:URIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-565-2537
Mailing Address - Street 1:89 HUDSON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5644
Mailing Address - Country:US
Mailing Address - Phone:201-565-2537
Mailing Address - Fax:
Practice Address - Street 1:89 HUDSON ST STE 200
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5644
Practice Address - Country:US
Practice Address - Phone:201-565-2537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty