Provider Demographics
NPI:1528680543
Name:EZEMA MED SERVICES LLC
Entity type:Organization
Organization Name:EZEMA MED SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:EZEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-338-4626
Mailing Address - Street 1:27 NASHAWAY DR
Mailing Address - Street 2:
Mailing Address - City:RINGOES
Mailing Address - State:NJ
Mailing Address - Zip Code:08551-2056
Mailing Address - Country:US
Mailing Address - Phone:908-338-4626
Mailing Address - Fax:
Practice Address - Street 1:27 NASHAWAY DR
Practice Address - Street 2:
Practice Address - City:RINGOES
Practice Address - State:NJ
Practice Address - Zip Code:08551-2056
Practice Address - Country:US
Practice Address - Phone:908-338-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6862004Medicaid