Provider Demographics
NPI:1346062429
Name:METUCHEN FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:METUCHEN FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAVJOT
Authorized Official - Middle Name:
Authorized Official - Last Name:SODHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-510-6044
Mailing Address - Street 1:3 WOODSIDE CT
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2572
Mailing Address - Country:US
Mailing Address - Phone:908-510-6044
Mailing Address - Fax:
Practice Address - Street 1:78 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2545
Practice Address - Country:US
Practice Address - Phone:908-510-6044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty