Provider Demographics
NPI:1144476961
Name:INFECTIOUS DISEASES ASSOCIATES OF NORTHERN NEW JERSEY LLC
Entity type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES OF NORTHERN NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-303-2055
Mailing Address - Street 1:255 W SPRING VALLEY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1444
Mailing Address - Country:US
Mailing Address - Phone:201-881-0107
Mailing Address - Fax:
Practice Address - Street 1:255 W SPRING VALLEY AVE STE 100
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1444
Practice Address - Country:US
Practice Address - Phone:201-881-0107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0181681207RI0200X
NJMA08081600207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty