Provider Demographics
NPI:1861607095
Name:UNIVERSAL MEDICAL CENTER, P.C.
Entity type:Organization
Organization Name:UNIVERSAL MEDICAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVSHITS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-797-8914
Mailing Address - Street 1:278 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-3525
Mailing Address - Country:US
Mailing Address - Phone:201-797-8914
Mailing Address - Fax:201-797-8916
Practice Address - Street 1:278 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-3525
Practice Address - Country:US
Practice Address - Phone:201-797-8914
Practice Address - Fax:201-797-8916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8080305Medicaid
NJ8080305Medicaid
052173Medicare PIN