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General NPI Number Information
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NPI Number | 1548602600
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Entity Type | Organization
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Legal Business Name | MEGA HEALTHCARE LLC
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 22 OLD SHORT HILLS RD SUITE 213
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5604
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Country | US
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Telephone | 973-544-6688
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Fax | 973-629-1919
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Provider Business Mailing Address
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Address Line | 1 SCHANCK DR
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City | EDISON
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State | NJ
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Zip | 08820-2417
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Country | US
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Telephone | 908-489-6800
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Fax |
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Authorized Official
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Title or Position | INTERNAL MEDICINE
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Name | DR. MADHAVI PENTYALA
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Credential | M.D.
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Telephone | 908-489-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 25MA07939700
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License Number State | NJ
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