Provider Demographics
NPI:1962575167
Name:VITAMED FAMILY PRACTICE
Entity type:Organization
Organization Name:VITAMED FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TADEUSZ
Authorized Official - Middle Name:JANUSZ
Authorized Official - Last Name:MAJCHRZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-963-0800
Mailing Address - Street 1:3000 KENNEDY BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-963-0800
Mailing Address - Fax:201-656-6934
Practice Address - Street 1:3000 KENNEDY BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306
Practice Address - Country:US
Practice Address - Phone:201-963-0800
Practice Address - Fax:201-656-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA5867500173000000X, 207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ092792Medicare PIN
NJF69505Medicare UPIN