Provider Demographics
NPI:1326211095
Name:JERSEY EMERGENCY MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:JERSEY EMERGENCY MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNACCONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-740-0607
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0509
Mailing Address - Country:US
Mailing Address - Phone:973-740-0607
Mailing Address - Fax:
Practice Address - Street 1:176 PALISADE AVE
Practice Address - Street 2:CHRIST HOSPITAL (EMERGENCY DEPARTMENT)
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1121
Practice Address - Country:US
Practice Address - Phone:201-795-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty