Provider Demographics
NPI:1144381567
Name:ALATAE MEDICAL LLC
Entity Type:Organization
Organization Name:ALATAE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-281-1077
Mailing Address - Street 1:390 AMWELL RD
Mailing Address - Street 2:BLDG 5 SUITE 501
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1248
Mailing Address - Country:US
Mailing Address - Phone:908-281-1077
Mailing Address - Fax:908-281-1081
Practice Address - Street 1:390 AMWELL RD
Practice Address - Street 2:BLDG 5 SUITE 501
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1248
Practice Address - Country:US
Practice Address - Phone:908-281-1077
Practice Address - Fax:908-281-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05520800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8918007Medicaid
063889Medicare ID - Type Unspecified
NJ8918007Medicaid