Basic Information
| Provider Information | |||||||||
| NPI: | 1083141782 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEASONS MEDICAL GROUP OF NEW JERSEY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 SHAFER CT | ||||||||
| Address2: | STE 700 | ||||||||
| City: | ROSEMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600184914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476921000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2445 KUSER RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | HAMILTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086903300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8662432157 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2017 | ||||||||
| LastUpdateDate: | 05/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | BILL | ||||||||
| AuthorizedOfficialFirstName: | CARRIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 8476921000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
No ID Information.