Provider Demographics
NPI:1306964747
Name:NORTHWEST MEDICAL CARE, LLC
Entity type:Organization
Organization Name:NORTHWEST MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRITHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLENGADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-252-1676
Mailing Address - Street 1:16 HEMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-2322
Mailing Address - Country:US
Mailing Address - Phone:973-252-1676
Mailing Address - Fax:
Practice Address - Street 1:66 SUNSET STRIP
Practice Address - Street 2:STE 407
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1345
Practice Address - Country:US
Practice Address - Phone:973-252-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099270Medicare PIN