Provider Demographics
NPI:1932584877
Name:JERSEY CITY FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:JERSEY CITY FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:M
Authorized Official - Last Name:VELOSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-239-9200
Mailing Address - Street 1:709 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2803
Mailing Address - Country:US
Mailing Address - Phone:201-239-9200
Mailing Address - Fax:201-239-7788
Practice Address - Street 1:709 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2803
Practice Address - Country:US
Practice Address - Phone:201-239-9200
Practice Address - Fax:201-239-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty