Provider Demographics
NPI:1912986761
Name:MIDDLESEX MEDICAL CARE PC
Entity type:Organization
Organization Name:MIDDLESEX MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARSGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-356-3212
Mailing Address - Street 1:619 UNION AVE
Mailing Address - Street 2:BUILDING 1 FIRST FLOOR
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1963
Mailing Address - Country:US
Mailing Address - Phone:732-356-3212
Mailing Address - Fax:732-356-5002
Practice Address - Street 1:619 UNION AVE
Practice Address - Street 2:BUILDING 1 FIRST FLOOR
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1963
Practice Address - Country:US
Practice Address - Phone:732-356-3212
Practice Address - Fax:732-356-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA061062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41191OtherAETNA GROUP NUMBER
NJ7520204Medicaid
NJ=========OtherUNITED GROUP NUMBER
NJ41191OtherAETNA GROUP NUMBER
NJ7520204Medicaid