Healthcare Provider Details

I. General information

NPI: 1386275352
Provider Name (Legal Business Name): MGM MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 WILLIAM ST
EAST ORANGE NJ
07017-4324
US

IV. Provider business mailing address

262 WILLIAM ST
EAST ORANGE NJ
07017-4324
US

V. Phone/Fax

Practice location:
  • Phone: 973-677-2231
  • Fax: 973-677-2231
Mailing address:
  • Phone: 973-677-2233
  • Fax: 973-677-2231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MALEKA ROBINSON
Title or Position: NURSE PRACTITIONER
Credential: APRN-BC, MSN, RN
Phone: 973-677-2233