Healthcare Provider Details

I. General information

NPI: 1750830030
Provider Name (Legal Business Name): MEDEXPRESS URGENT CARE - NORTHERN NEW JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 MOUNTAIN AVE
HACKETTSTOWN NJ
07840-2409
US

IV. Provider business mailing address

1001 CONSOL ENERGY DR
CANONSBURG PA
15317-6506
US

V. Phone/Fax

Practice location:
  • Phone: 908-852-2470
  • Fax: 908-850-1730
Mailing address:
  • Phone: 304-225-2500
  • Fax: 724-743-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRETT GALL
Title or Position: DIRECTOR PAYOR CONTRACTING
Credential:
Phone: 304-225-2500