MEDICARE: MEDEMERGE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	057453	OTHER	NJ	MEDICARE GROUP PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366656431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDEMERGE LLC

Provider Business Mailing Address
First Line	:	1005 N WASHINGTON AVE
Second Line	:
City	:	GREEN BROOK
State	:	NJ
Zip	:	08812-2619
Country	:	US
Telephone Number	:	732-968-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 N WASHINGTON AVE
Second Line	:
City	:	GREEN BROOK
State	:	NJ
Zip	:	08812-2619
Country	:	US
Telephone Number	:	732-968-8900
Fax Number	:	732-968-4609

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	JOSHUA BERSHAD
Credential	:
Telephone Number	:	732-212-0051

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	03/31/2023

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Directions to “MEDEMERGE LLC ” Practice Location

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