MEDICARE: BMG NEWARK 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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician	25MA08818300	NJ
3	261QU0200X	Urgent Care Clinic/Center

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	:	1811408172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BMG NEWARK LLC

Provider Business Mailing Address
First Line	:	110 SQUIRE HILL RD
Second Line	:
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-2516
Country	:	US
Telephone Number	:	973-370-4000
Fax Number	:	862-904-0044

Provider Business Practice Location Address
First Line	:	794 MOUNT PROSPECT AVE FL 2
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-3221
Country	:	US
Telephone Number	:	973-777-0000
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. HR MANAGER
Credential	:
Telephone Number	:	973-777-0000

Provider Enumeration Date	:	10/13/2017
Last Update Date	:	07/29/2025

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Directions to “BMG NEWARK LLC ” Practice Location

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