Provider Demographics
NPI:1215598826
Name:MEDCARE PRACTICE, LLC
Entity Type:Organization
Organization Name:MEDCARE PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIETTE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:AMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-379-4538
Mailing Address - Street 1:2 UNIVERSITY PLAZA
Mailing Address - Street 2:SUITE 100 #29
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6210
Mailing Address - Country:US
Mailing Address - Phone:201-967-8425
Mailing Address - Fax:201-263-4665
Practice Address - Street 1:2 UNIVERSITY PLAZA
Practice Address - Street 2:SUITE 100 #29
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6210
Practice Address - Country:US
Practice Address - Phone:908-578-2144
Practice Address - Fax:732-379-4538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08528000OtherLICENSE