Healthcare Provider Details

I. General information

NPI: 1295261568
Provider Name (Legal Business Name): MEDICAL HEALTH CENTER OF MIDDLETOWN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 HIGHWAY 35
MIDDLETOWN NJ
07748
US

IV. Provider business mailing address

1270 HIGHWAY 35
MIDDLETOWN NJ
07748-2014
US

V. Phone/Fax

Practice location:
  • Phone: 732-615-3900
  • Fax: 732-615-0185
Mailing address:
  • Phone: 732-615-3900
  • Fax: 732-615-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB07926900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA05272000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA06412300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN09409300
License Number StateNJ

VIII. Authorized Official

Name: JOSEPH CLEMENTE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 732-615-3900