Provider Demographics
NPI:1033570858
Name:MCMJ HEALTHCARE AGENCY, LLC
Entity Type:Organization
Organization Name:MCMJ HEALTHCARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-452-0130
Mailing Address - Street 1:637 WYCKOFF AVE
Mailing Address - Street 2:SUITE 278
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-1438
Mailing Address - Country:US
Mailing Address - Phone:201-857-4190
Mailing Address - Fax:201-857-4191
Practice Address - Street 1:10 MILLINGTON DR
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1112
Practice Address - Country:US
Practice Address - Phone:201-857-4190
Practice Address - Fax:201-857-4191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0200800251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health