Provider Demographics
NPI:1881336428
Name:VISAVIS HEALTH CARE MEDICAL GROUP OF NJ LLC
Entity type:Organization
Organization Name:VISAVIS HEALTH CARE MEDICAL GROUP OF NJ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YITTY
Authorized Official - Middle Name:
Authorized Official - Last Name:FALKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-734-6621
Mailing Address - Street 1:250 SKILLMAN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1218
Mailing Address - Country:US
Mailing Address - Phone:212-734-6621
Mailing Address - Fax:
Practice Address - Street 1:12-15 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5808
Practice Address - Country:US
Practice Address - Phone:212-734-6621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty