Provider Demographics
NPI:1265141444
Name:TRI AMERICA MEDICINE LLC
Entity type:Organization
Organization Name:TRI AMERICA MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-755-8102
Mailing Address - Street 1:2185 LEMOINE AVE UNIT 1H
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6030
Mailing Address - Country:US
Mailing Address - Phone:844-755-8102
Mailing Address - Fax:
Practice Address - Street 1:2185 LEMOINE AVE UNIT 1H
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6030
Practice Address - Country:US
Practice Address - Phone:844-755-8102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI AMERICA HEALTH & WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-16
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ783075OtherMEDICARE