Provider Demographics
NPI:1164615126
Name:METROPOLITAN COMMUNITY MEDICAL CARE LLC
Entity Type:Organization
Organization Name:METROPOLITAN COMMUNITY MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKLER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:908-994-1500
Mailing Address - Street 1:500 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1642
Mailing Address - Country:US
Mailing Address - Phone:908-994-1500
Mailing Address - Fax:908-994-0035
Practice Address - Street 1:500 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1642
Practice Address - Country:US
Practice Address - Phone:908-994-1500
Practice Address - Fax:908-994-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07280100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care