Healthcare Provider Details

I. General information

NPI: 1245954254
Provider Name (Legal Business Name): CCG MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 MORRIS AVE STE 201
SPRINGFIELD NJ
07081-1512
US

IV. Provider business mailing address

673 MORRIS AVE STE 201
SPRINGFIELD NJ
07081-1512
US

V. Phone/Fax

Practice location:
  • Phone: 973-759-9000
  • Fax:
Mailing address:
  • Phone: 973-759-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLIFFORD SALES
Title or Position: MANAGING BUSINESS PARTNER
Credential: MD
Phone: 973-759-9000