Second Street Medical Associates

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MA67550 Issued in NJ

Legal business name

SECOND STREET MEDICAL ASSOCIATES

Practice address

386 2ND St
Hackensack, NJ 07601-2731

Phone

(201) 342-1877

Fax

(201) 342-1879

NPI assigned

May 8, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Philip G Woodham, MD

Title

Owner

Phone

(201) 342-1877

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363737600000",
    "number": "1679522775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "386 2ND ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076012731",
            "telephone_number": "201-342-1877",
            "fax_number": "201-342-1879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "386 2ND ST",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076012731",
            "telephone_number": "201-342-1877",
            "fax_number": "201-342-1879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND STREET MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2013-03-20",
        "status": "A",
        "authorized_official_last_name": "WOODHAM",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-342-1877",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "MA67550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Hackensack, NJ
• Providers in Hackensack, NJ by specialty
• Primary Care Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; 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.