Provider Demographics
NPI:1912060930
Name:JERSEY MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:JERSEY MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINUTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJASEKHARAIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-952-5693
Mailing Address - Street 1:200,PERRINE ROAD,SUITE 206,OLD BRIDGE PROF.PLAZA
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751
Mailing Address - Country:US
Mailing Address - Phone:732-952-5693
Mailing Address - Fax:732-952-5694
Practice Address - Street 1:200,PERRINE ROAD,SUITE 206,OLD BRIDGE PROF.PLAZA
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07751
Practice Address - Country:US
Practice Address - Phone:732-952-5693
Practice Address - Fax:732-952-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07380600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ097155Medicare ID - Type Unspecified