Provider Demographics
NPI:1437352119
Name:RJZM LLC
Entity type:Organization
Organization Name:RJZM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLINGSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-292-0100
Mailing Address - Street 1:2604 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-1199
Mailing Address - Country:US
Mailing Address - Phone:718-292-0100
Mailing Address - Fax:718-866-0163
Practice Address - Street 1:110-20 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:718-850-4644
Practice Address - Fax:718-849-4644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RJZM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-08
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7000259R208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02100810Medicaid
NY06030OtherMEDICARE PTAN