Provider Demographics
NPI:1528347101
Name:MILLENNIUM HEALTHCARE OF CLIFTON, LLC
Entity type:Organization
Organization Name:MILLENNIUM HEALTHCARE OF CLIFTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ZEV
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-249-7700
Mailing Address - Street 1:925 CLIFTON AVE
Mailing Address - Street 2:SUITE #201
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2724
Mailing Address - Country:US
Mailing Address - Phone:973-249-7700
Mailing Address - Fax:973-249-7705
Practice Address - Street 1:925 CLIFTON AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2724
Practice Address - Country:US
Practice Address - Phone:973-249-7700
Practice Address - Fax:973-249-7705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-12
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31C0001301OtherMEDICARE CCN