Basic Information
| Provider Information | |||||||||
| NPI: | 1255894051 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW JERSEY INTERVENTIONAL ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 416157 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022416157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106448900 | ||||||||
| FaxNumber: | 4849240053 | ||||||||
| Practice Location | |||||||||
| Address1: | 1050 GALLOPING HILL RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070837980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086861382 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2019 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | GREGG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6106448900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.