Provider Demographics
NPI:1366656431
Name:MEDEMERGE LLC
Entity Type:Organization
Organization Name:MEDEMERGE LLC
Other - Org Name:MEDEMERGE MEDICAL ASSOCIATES, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERSHAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-212-0051
Mailing Address - Street 1:1005 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-2619
Mailing Address - Country:US
Mailing Address - Phone:732-968-8900
Mailing Address - Fax:
Practice Address - Street 1:1005 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-2619
Practice Address - Country:US
Practice Address - Phone:732-968-8900
Practice Address - Fax:732-968-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8805903Medicaid
NJ057453OtherMEDICARE GROUP PROVIDER NUMBER
NJ8805903Medicaid