Provider Demographics
NPI:1447622402
Name:URGENT CARE PHYSICIANS OF NEW JERSEY, LLC
Entity type:Organization
Organization Name:URGENT CARE PHYSICIANS OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WACIEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-630-8947
Mailing Address - Street 1:46 NEWMAN SPRINGS RD E STE F
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1531
Mailing Address - Country:US
Mailing Address - Phone:973-630-8947
Mailing Address - Fax:
Practice Address - Street 1:46 NEWMAN SPRINGS RD E STE F
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1531
Practice Address - Country:US
Practice Address - Phone:973-630-8947
Practice Address - Fax:973-630-8947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07201000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0552020Medicaid