Provider Demographics
NPI:1154662153
Name:A1 MEDICAL CARE PC
Entity Type:Organization
Organization Name:A1 MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RADHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDALI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:973-678-2900
Mailing Address - Street 1:310 CENTRAL AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2835
Mailing Address - Country:US
Mailing Address - Phone:973-678-2900
Mailing Address - Fax:973-678-8183
Practice Address - Street 1:310 CENTRAL AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2835
Practice Address - Country:US
Practice Address - Phone:973-678-2900
Practice Address - Fax:973-678-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07474500261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0105481Medicaid
NJI11850Medicare UPIN
NJ081474Medicare PIN