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NPI Code Detail

MEDICARE: MEDEMERGE P.A.

MEDICARE: MEDEMERGE P.A.
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1184643132
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDEMERGE P.A.
Provider Business Mailing Address
First Line : PO BOX 890
Second Line :
City : GREEN BROOK
State : NJ
Zip : 08812-2619
Country : US
Telephone Number : 732-968-8900
Fax Number : 732-968-4898
Provider Business Practice Location Address
First Line : 1005 N. WASHINGTON AVE
Second Line :
City : GREEN BROOK
State : NJ
Zip : 08812-2619
Country : US
Telephone Number : 732-968-8900
Fax Number : 732-968-4898
Authorized Official
Title or Position : DIRECTOR
Name : JOHN D. PILLA
Credential : MD
Telephone Number : 732-968-8900
Provider Enumeration Date : 07/19/2006
Last Update Date : 01/03/2012

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Directions to “MEDEMERGE P.A. ” Practice Location

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