Provider Demographics
NPI:1831595776
Name:01 MEDICAL GROUP LLC
Entity type:Organization
Organization Name:01 MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STOKES
Authorized Official - Last Name:AITKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-318-4411
Mailing Address - Street 1:2328 10TH AVE N FL 3
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-6606
Mailing Address - Country:US
Mailing Address - Phone:888-443-3869
Mailing Address - Fax:
Practice Address - Street 1:16-01 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2026
Practice Address - Country:US
Practice Address - Phone:888-443-3869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty