Provider Demographics
NPI:1962613554
Name:MEDICAL ASSOCIATES FOR CENTRAL NEW JERSEY P .A.
Entity type:Organization
Organization Name:MEDICAL ASSOCIATES FOR CENTRAL NEW JERSEY P .A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-257-1600
Mailing Address - Street 1:26 THROCKMORTON LN
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2520
Mailing Address - Country:US
Mailing Address - Phone:732-257-1600
Mailing Address - Fax:732-257-2002
Practice Address - Street 1:26 THROCKMORTON LN
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2520
Practice Address - Country:US
Practice Address - Phone:732-257-1600
Practice Address - Fax:732-257-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03134100207Q00000X
NJ25MA07646700207R00000X
NJ25MA059820207RC0000X
NJ25MA85423488207RP1001X
NJ25MA84518600207RP1001X
NJ25MA05018700207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3441407Medicaid
NJ880154338Medicare PIN
NJ3441407Medicaid
NJ607909Medicare PIN
NJG65809Medicare UPIN