Provider Demographics
NPI:1184843435
Name:CENTRAL JERSEY MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:CENTRAL JERSEY MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHZINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NADEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-586-3636
Mailing Address - Street 1:1445 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3834
Mailing Address - Country:US
Mailing Address - Phone:609-586-3636
Mailing Address - Fax:609-586-8770
Practice Address - Street 1:1445 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3834
Practice Address - Country:US
Practice Address - Phone:609-586-3636
Practice Address - Fax:609-586-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA066554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7803605Medicaid
NJ7803605Medicaid
NJ004779YVYMedicare PIN
NJG65675Medicare UPIN