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General NPI Number Information
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NPI Number | 1831678887
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Entity Type | Organization
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Legal Business Name | MEDICOR LIFESTYLE MEDICINE, P.A
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 331 US HIGHWAY 206
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-4781
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Country | US
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Telephone | 908-243-5004
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Fax | 908-904-1403
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Provider Business Mailing Address
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Address Line | 225 JACKSON ST
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-3060
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Country | US
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Telephone | 908-243-5004
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Fax | 908-904-1403
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOHN E PUGH
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Credential |
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Telephone | 908-243-5002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC3500X
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Taxonomy Name | Cardiac Rehabilitation Registered Nurse
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License Number |
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License Number State |
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