Healthcare Provider Details

I. General information

NPI: 1245523869
Provider Name (Legal Business Name): PRACTICE ASSOCIATES MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 MORRIS AVE SUITE 100
SPRINGFIELD NJ
07081-1151
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-379-2111
  • Fax: 973-379-2807
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER ALOYCE HERZOG
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 973-829-4320