Healthcare Provider Details

I. General information

NPI: 1912328873
Provider Name (Legal Business Name): ALLSTATE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 JOHNSON RD
SOMERSET NJ
08873-2930
US

IV. Provider business mailing address

16 JOHNSON RD
SOMERSET NJ
08873-2930
US

V. Phone/Fax

Practice location:
  • Phone: 908-315-5299
  • Fax:
Mailing address:
  • Phone: 908-315-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: BIANCA MCCALL
Title or Position: OWNER
Credential:
Phone: 908-397-8538