MEDICARE: ALATAE MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25MA05520800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144381567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALATAE MEDICAL LLC

Provider Business Mailing Address
First Line	:	390 AMWELL RD
Second Line	:	BLDG 5 SUITE 501
City	:	HILLSBOROUGH
State	:	NJ
Zip	:	08844-1248
Country	:	US
Telephone Number	:	908-281-1077
Fax Number	:	908-281-1081

Provider Business Practice Location Address
First Line	:	390 AMWELL RD
Second Line	:	BLDG 5 SUITE 501
City	:	HILLSBOROUGH
State	:	NJ
Zip	:	08844-1248
Country	:	US
Telephone Number	:	908-281-1077
Fax Number	:	908-281-1081

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NANCY E ALLEGAR
Credential	:	MD
Telephone Number	:	908-281-1077

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	06/09/2008

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Directions to “ALATAE MEDICAL LLC ” Practice Location

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