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General NPI Number Information
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NPI Number | 1114173028
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Entity Type | Organization
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Legal Business Name | MIDDLESEX COMMUNITY MEDICALCARE, LLC
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 530 UNION AVE SUITE #2
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City | MIDDLESEX
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State | NJ
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Zip | 08846-1934
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Country | US
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Telephone | 732-667-3287
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Fax | 732-667-3289
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Provider Business Mailing Address
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Address Line | 530 UNION AVE SUITE #2
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City | MIDDLESEX
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State | NJ
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Zip | 08846-1934
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Country | US
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Telephone | 732-667-3287
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Fax | 732-667-3289
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEETA YALAMANCHI
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Credential | M.D.
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Telephone | 732-667-3287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA08109500
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License Number State | NJ
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