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127 Lafayette St Jersey City NJ 07304-3615 | |
| (201) 451-5425 | |
| (201) 451-7499 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 127 Lafayette St, Jersey City, New Jersey |
| Authorized Official Name and Position | Larry M Blake (CEO) |
| Authorized Official Contact | 2013869264 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
P.o Box 4070 75 Harrison Ave Jersey City NJ 07304-0070 Ph: (201) 451-5425 | 127 Lafayette St Jersey City NJ 07304-3615 Ph: (201) 451-5425 |
| NPI Number | 1306969787 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 11/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306969787 | NPI | - | NPPES |
| 7864108 | Medicaid | NJ | |
| 6103201 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 80305 (New Jersey) | Primary |
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