=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780816173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MADAD GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2009
-----------------------------------------------------
Last Update Date | 08/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 513 W MOUNT PLEASANT AVE
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-341-0570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 957 ROUTE 33 STE 330
-----------------------------------------------------
City | HAMILTON SQUARE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GARY R WEINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 201-341-0570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 25MA03540500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------