Basic Information
| Provider Information | |||||||||
| NPI: | 1467576108 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW JERSEY/PENNSYLVANIA EM-I MEDICAL SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1717 MAIN ST | ||||||||
| Address2: | SUITE 5200 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752014612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2147122000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 JEFFERSON AVE | ||||||||
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| City: | JEANNETTE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156442539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245273551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 02/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2154425000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.