Basic Information
| Provider Information | |||||||||
| NPI: | 1093120362 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EMERGIMED PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 663 PALISADE AVE | ||||||||
| Address2: | |||||||||
| City: | CLIFFSIDE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070103012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019456500 | ||||||||
| FaxNumber: | 2019451157 | ||||||||
| Practice Location | |||||||||
| Address1: | 663 PALISADE AVE | ||||||||
| Address2: | |||||||||
| City: | CLIFFSIDE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070103012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019456500 | ||||||||
| FaxNumber: | 2019451157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2014 | ||||||||
| LastUpdateDate: | 06/25/2014 | ||||||||
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| AuthorizedOfficialLastName: | CHOUAKE | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2019456500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.