Provider Demographics
NPI:1225134695
Name:FIRST CARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:FIRST CARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMBROSIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-857-8995
Mailing Address - Street 1:PO BOX 36072
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07188-6006
Mailing Address - Country:US
Mailing Address - Phone:973-857-8995
Mailing Address - Fax:973-857-7034
Practice Address - Street 1:50 POMPTON AVENUE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044
Practice Address - Country:US
Practice Address - Phone:973-857-8995
Practice Address - Fax:973-857-7034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA037714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000471084OtherHIGH MARK BS
NJ0K2192OtherHEALTHNET
NJ0107835001OtherAMERIHEALTH
NJ=========OtherHORIZON
NJ000471084OtherHIGH MARK BS
NJ=========OtherAETNA
NJ0580300001Medicare NSC
NJD06336Medicare UPIN
NJ471084Medicare PIN
NJ000471084OtherHIGH MARK BS