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General NPI Number Information
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NPI Number | 1750830030
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Entity Type | Organization
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Legal Business Name | MEDEXPRESS URGENT CARE - NORTHERN NEW JERSEY, PC
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 228 MOUNTAIN AVE
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City | HACKETTSTOWN
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State | NJ
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Zip | 07840-2409
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Country | US
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Telephone | 908-852-2470
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Fax | 908-850-1730
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Provider Business Mailing Address
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Address Line | 1001 CONSOL ENERGY DR
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City | CANONSBURG
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State | PA
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Zip | 15317-6506
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Country | US
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Telephone | 304-225-2500
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Fax | 724-743-1133
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Authorized Official
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Title or Position | DIRECTOR PAYOR CONTRACTING
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Name | BRETT GALL
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Credential |
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Telephone | 304-225-2500
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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 | 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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