Provider Demographics
NPI:1346314358
Name:THE MEDICAL GROUP P.A.
Entity Type:Organization
Organization Name:THE MEDICAL GROUP P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MORELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-325-0061
Mailing Address - Street 1:745 NORTHFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1144
Mailing Address - Country:US
Mailing Address - Phone:973-325-0061
Mailing Address - Fax:973-325-0219
Practice Address - Street 1:745 NORTHFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1144
Practice Address - Country:US
Practice Address - Phone:973-325-0061
Practice Address - Fax:973-325-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCB7356OtherRAILROAD MEDICARE
NJCB7356OtherRAILROAD MEDICARE