MEDICARE: MADAD GROUP INC

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	25MA03540500	NJ

General Provider Information

NPI Number	:	1780816173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADAD GROUP INC

Provider Business Mailing Address
First Line	:	957 ROUTE 33 STE 330
Second Line	:
City	:	HAMILTON SQUARE
State	:	NJ
Zip	:	08690-2727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	513 W MOUNT PLEASANT AVE
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1710
Country	:	US
Telephone Number	:	201-341-0570
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARY R WEINE
Credential	:	MD
Telephone Number	:	201-341-0570

Provider Enumeration Date	:	08/18/2009
Last Update Date	:	08/18/2009

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