Healthcare Provider Details

I. General information

NPI: 1972653624
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF CENTRAL JERSEY,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CLYDE RD STE 102
SOMERSET NJ
08873-5043
US

IV. Provider business mailing address

21 CLYDE RD STE 102
SOMERSET NJ
08873-5043
US

V. Phone/Fax

Practice location:
  • Phone: 732-422-8440
  • Fax: 732-422-8404
Mailing address:
  • Phone: 732-422-8440
  • Fax: 732-422-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMA062819
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMA062819
License Number StateNJ

VIII. Authorized Official

Name: DR. MIR SHARIF AHMAD
Title or Position: PRESIDENT
Credential: MD
Phone: 732-422-8440