Healthcare Provider Details

I. General information

NPI: 1376006486
Provider Name (Legal Business Name): MGV MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 S FRANKLIN TPKE STE 104
RAMSEY NJ
07446-2558
US

IV. Provider business mailing address

48 S FRANKLIN TPKE STE 104
RAMSEY NJ
07446-2558
US

V. Phone/Fax

Practice location:
  • Phone: 201-962-9199
  • Fax:
Mailing address:
  • Phone: 201-962-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MCELROY
Title or Position: MEMBER
Credential: DO
Phone: 201-962-9199