Provider Demographics
NPI:1194911172
Name:US MEDGROUP OF NEW JERSEY, P.A.
Entity type:Organization
Organization Name:US MEDGROUP OF NEW JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, CMO
Authorized Official - Prefix:MR
Authorized Official - First Name:W
Authorized Official - Middle Name:TOM
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-232-3550
Mailing Address - Street 1:5080 SPECTRUM DR
Mailing Address - Street 2:SUITE 1200 WEST TOWER
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4648
Mailing Address - Country:US
Mailing Address - Phone:800-232-3550
Mailing Address - Fax:866-465-4208
Practice Address - Street 1:989 CORPORATE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-2227
Practice Address - Country:US
Practice Address - Phone:888-809-3214
Practice Address - Fax:410-850-4264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service