Basic Information
| Provider Information | |||||||||
| NPI: | 1083620348 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIDGEFIELD MEDICAL ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 865 TEANECK RD | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013421205 | ||||||||
| FaxNumber: | 2013421259 | ||||||||
| Practice Location | |||||||||
| Address1: | 865 TEANECK RD | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076664513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013421205 | ||||||||
| FaxNumber: | 2013421259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 03/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | ROSEN | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2013421205 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.