MEDICARE: MONTGOMERY MEDICAL ASSOCIATES 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	MB070954	NJ

General Provider Information

NPI Number	:	1366501462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY MEDICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	9 DUTCHTOWN HARLINGEN RD
Second Line	:
City	:	BELLE MEAD
State	:	NJ
Zip	:	08502-5115
Country	:	US
Telephone Number	:	908-874-8883
Fax Number	:	908-874-3595

Provider Business Practice Location Address
First Line	:	9 DUTCHTOWN HARLINGEN RD
Second Line	:
City	:	BELLE MEAD
State	:	NJ
Zip	:	08502-5115
Country	:	US
Telephone Number	:	908-874-8883
Fax Number	:	908-874-3595

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH J PECORA III
Credential	:	DO
Telephone Number	:	908-874-8883

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	12/22/2009

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