Internal Medicine & Geriatric Specialist of North Jersey, LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

25MB07249800 Issued in NJ

Legal business name

INTERNAL MEDICINE & GERIATRIC SPECIALIST OF NORTH JERSEY, LLC

Practice address

2811 Kennedy Blvd
North Bergen, NJ 07047-2227

Phone

(201) 319-0008

Fax

(201) 319-0004

NPI assigned

Sep 11, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Debi Smith

Title

Account Executive

Phone

(201) 376-0770

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221091200000",
    "number": "1538318795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 KENNEDY BLVD",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070472227",
            "telephone_number": "201-319-0008",
            "fax_number": "201-319-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 KENNEDY BLVD",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070472227",
            "telephone_number": "201-319-0008",
            "fax_number": "201-319-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE & GERIATRIC SPECIALIST OF NORTH JERSEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-11",
        "last_updated": "2008-09-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DEBI",
        "authorized_official_title_or_position": "ACCOUNT EXECUTIVE",
        "authorized_official_telephone_number": "201-376-0770",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MB07249800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.