Provider Demographics
NPI:1598180523
Name:JEFFERSON MEDICAL CARE
Entity type:Organization
Organization Name:JEFFERSON MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOROVITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-928-3840
Mailing Address - Street 1:385 LAKEVIEW AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-4075
Mailing Address - Country:US
Mailing Address - Phone:973-928-3840
Mailing Address - Fax:973-928-3842
Practice Address - Street 1:385 LAKEVIEW AVE STE 4
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-4075
Practice Address - Country:US
Practice Address - Phone:973-928-3840
Practice Address - Fax:973-928-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061228L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG44222Medicare UPIN