Provider Demographics
NPI:1356660427
Name:MEDICAL GROUP ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MEDICAL GROUP ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-845-8010
Mailing Address - Street 1:190 NORTH EVERGREEN AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08086-1862
Mailing Address - Country:US
Mailing Address - Phone:856-845-8010
Mailing Address - Fax:856-845-9398
Practice Address - Street 1:400 GROVE ROAD
Practice Address - Street 2:
Practice Address - City:THOROFARE
Practice Address - State:NJ
Practice Address - Zip Code:08086-0037
Practice Address - Country:US
Practice Address - Phone:856-845-8010
Practice Address - Fax:856-845-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO5594500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty