Healthcare Provider Details

I. General information

NPI: 1184036717
Provider Name (Legal Business Name): BCT MEDICAL ASSOCIATES.LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 DURHAM AVE SUITE 1 A BLD 6
SOUTH PLAINFIELD NJ
07080-2546
US

IV. Provider business mailing address

590 HARTFORD DR
NUTLEY NJ
07110-3948
US

V. Phone/Fax

Practice location:
  • Phone: 732-718-3165
  • Fax:
Mailing address:
  • Phone: 732-718-3165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: BAO CHAU MINH TRAN
Title or Position: OWNER
Credential: MD
Phone: 732-338-0228