Provider Demographics
NPI:1366501462
Name:MONTGOMERY MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:MONTGOMERY MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:PECORA
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:908-874-8883
Mailing Address - Street 1:9 DUTCHTOWN HARLINGEN RD
Mailing Address - Street 2:
Mailing Address - City:BELLE MEAD
Mailing Address - State:NJ
Mailing Address - Zip Code:08502-5115
Mailing Address - Country:US
Mailing Address - Phone:908-874-8883
Mailing Address - Fax:908-874-3595
Practice Address - Street 1:9 DUTCHTOWN HARLINGEN RD
Practice Address - Street 2:
Practice Address - City:BELLE MEAD
Practice Address - State:NJ
Practice Address - Zip Code:08502-5115
Practice Address - Country:US
Practice Address - Phone:908-874-8883
Practice Address - Fax:908-874-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB070954207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ108081Medicare PIN
NJH41676Medicare UPIN