Provider Demographics
NPI:1114173028
Name:MIDDLESEX COMMUNITY MEDICALCARE, LLC
Entity Type:Organization
Organization Name:MIDDLESEX COMMUNITY MEDICALCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEETA
Authorized Official - Middle Name:
Authorized Official - Last Name:YALAMANCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-667-3287
Mailing Address - Street 1:530 UNION AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1934
Mailing Address - Country:US
Mailing Address - Phone:732-667-3287
Mailing Address - Fax:732-667-3289
Practice Address - Street 1:530 UNION AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1934
Practice Address - Country:US
Practice Address - Phone:732-667-3287
Practice Address - Fax:732-667-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08109500261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ168027Medicare UPIN