Healthcare Provider Details

I. General information

NPI: 1205353471
Provider Name (Legal Business Name): MEDEXPRESS URGENT CARE - NEW JERSEY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 NJ ROUTE 35 SUITE 100
WALL NJ
07719-3512
US

IV. Provider business mailing address

1001 CONSOL ENERGY DR
CANONSBURG PA
15317-6506
US

V. Phone/Fax

Practice location:
  • Phone: 732-449-1352
  • Fax: 732-449-1353
Mailing address:
  • Phone: 304-225-2500
  • Fax: 724-743-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRETT GALL
Title or Position: DIRECTOR PAYOR CONTRACTING
Credential:
Phone: 304-225-2500