Provider Demographics
NPI:1396252318
Name:EMG MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:EMG MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-297-4714
Mailing Address - Street 1:329 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-5804
Mailing Address - Country:US
Mailing Address - Phone:201-762-6050
Mailing Address - Fax:201-762-6050
Practice Address - Street 1:329 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5804
Practice Address - Country:US
Practice Address - Phone:201-762-6050
Practice Address - Fax:201-762-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-30
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty