Basic Information
| Provider Information | |||||||||
| NPI: | 1477927754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROHEALTH URGENT CARE MEDICINE OF NEW JERSEY LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 MARCUS AVE | ||||||||
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| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166226000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 461 RIVER RD | ||||||||
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| City: | EDGEWATER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070201145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166226000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2015 | ||||||||
| LastUpdateDate: | 11/25/2015 | ||||||||
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| AuthorizedOfficialLastName: | PELLMAN | ||||||||
| AuthorizedOfficialFirstName: | ELLIOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 5166226000 | ||||||||
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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 | 261QE0002X | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.