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NPI Code Detail

MEDICARE: PHYSICIAN MANAGEMENT SERVICES OF NEW JERSEY, LLC

MEDICARE: PHYSICIAN MANAGEMENT SERVICES OF NEW JERSEY, 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1629348503
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIAN MANAGEMENT SERVICES OF NEW JERSEY, LLC
Provider Business Mailing Address
First Line : 800 N MAGNOLIA AVE STE 700
Second Line :
City : ORLANDO
State : FL
Zip : 32803-3264
Country : US
Telephone Number : 888-829-8550
Fax Number : 859-422-4907
Provider Business Practice Location Address
First Line : 170 CHANGEBRIDGE RD BLDG C3
Second Line :
City : MONTVILLE
State : NJ
Zip : 07045-9112
Country : US
Telephone Number : 888-829-8550
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : CASEY DELOACH
Credential :
Telephone Number : 888-829-8550
Provider Enumeration Date : 01/09/2012
Last Update Date : 05/21/2026

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Directions to “PHYSICIAN MANAGEMENT SERVICES OF NEW JERSEY, LLC ” Practice Location

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