Organization Name: | MEADOWLANDS PHYSICIANS PROFESSIONAL ASSOCIATION |
NPI Number: | 1669728283 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROMAN KOSIBOROD (OWNER) |
Mailing Address: | 55 Meadowlands Pkwy Secaucus |
State: | NJ US |
Postal Code: | 070942977 |
Phone Number: | 2019824706 |
Fax Number: | |
NPI Enumeration Date: | 08/01/2012 |
NPI Last Update Date: | 12/18/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |