MEDICARE: BRIDGEWATER MEDICAL GROUP

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	261QM1300X	Multi-Specialty Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2182	OTHER	NJ	AETNA US HEALTHCARE GROUP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821031568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEWATER MEDICAL GROUP

Provider Business Mailing Address
First Line	:	766 US HIGHWAY 202/206
Second Line	:	SUITE 1
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807-1777
Country	:	US
Telephone Number	:	908-722-0808
Fax Number	:	908-722-3415

Provider Business Practice Location Address
First Line	:	766 US HIGHWAY 202/206 NORTH
Second Line	:	SUITE 1
City	:	BRIDGEWATER
State	:	NJ
Zip	:	08807-1773
Country	:	US
Telephone Number	:	908-722-0808
Fax Number	:	908-722-3415

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT H LUSTIG
Credential	:	D.O.
Telephone Number	:	908-722-0808

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	06/20/2012

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Directions to “BRIDGEWATER MEDICAL GROUP ” Practice Location

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