Provider Demographics
NPI:1386275352
Name:MGM MEDICAL CENTER
Entity type:Organization
Organization Name:MGM MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MALEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC, MSN, RN
Authorized Official - Phone:973-677-2233
Mailing Address - Street 1:262 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-4324
Mailing Address - Country:US
Mailing Address - Phone:973-677-2233
Mailing Address - Fax:973-677-2231
Practice Address - Street 1:262 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-4324
Practice Address - Country:US
Practice Address - Phone:973-677-2231
Practice Address - Fax:973-677-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care