Basic Information
| Provider Information | |||||||||
| NPI: | 1376593137 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXIGENCE NEW JERSEY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6653 MAIN ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162044500 | ||||||||
| FaxNumber: | 7162044501 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 WOODSTOWN RD | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | SALEM | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080792064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162044500 | ||||||||
| FaxNumber: | 7162044501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 11/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | LEVY | ||||||||
| AuthorizedOfficialFirstName: | IRVING | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7162044500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 083194 | 05 | NJ | MEDICAID |