Healthcare Provider Details

I. General information

NPI: 1619018702
Provider Name (Legal Business Name): MILLTOWN MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 MILLTOWN RD
SPRINGFIELD NJ
07081-2445
US

IV. Provider business mailing address

406 MILLTOWN RD
SPRINGFIELD NJ
07081-2445
US

V. Phone/Fax

Practice location:
  • Phone: 973-921-1777
  • Fax: 973-921-1790
Mailing address:
  • Phone: 973-921-1777
  • Fax: 973-921-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberMA07612800
License Number StateNJ

VIII. Authorized Official

Name: DR. JUDE GERMAINE-MUNOZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 973-921-1777