Healthcare Provider Details

I. General information

NPI: 1366656431
Provider Name (Legal Business Name): MEDEMERGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N WASHINGTON AVE
GREEN BROOK NJ
08812-2619
US

IV. Provider business mailing address

1005 N WASHINGTON AVE
GREEN BROOK NJ
08812-2619
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-8900
  • Fax: 732-968-4609
Mailing address:
  • Phone: 732-968-8900
  • Fax:

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: JOSHUA BERSHAD
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 732-212-0051