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General NPI Number Information
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NPI Number | 1134939333
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Entity Type | Organization
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Legal Business Name | LIFE MEDICAL GROUP, PC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 70 S ORANGE AVE STE 235
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4915
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Country | US
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Telephone | 739-607-4911
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Fax |
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Provider Business Mailing Address
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Address Line | 70 S ORANGE AVE STE 235
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4915
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Country | US
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Telephone | 551-225-0800
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. MARK A MERLIN
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Credential |
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Telephone | 551-225-0080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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