Healthcare Provider Details

I. General information

NPI: 1982014791
Provider Name (Legal Business Name): JMD FAMILY PRACTICE, L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 KINGS CT STE 203
FLEMINGTON NJ
08822-6019
US

IV. Provider business mailing address

2 KINGS CT STE 203
FLEMINGTON NJ
08822-6019
US

V. Phone/Fax

Practice location:
  • Phone: 908-751-5439
  • Fax: 908-751-5478
Mailing address:
  • Phone: 908-751-5439
  • Fax: 908-751-5478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA05652500
License Number StateNJ

VIII. Authorized Official

Name: DR. JOHN MCDONOUGH
Title or Position: OWNER
Credential: M.D.
Phone: 908-788-7846