Provider Demographics
NPI:1386675718
Name:NORTHERN MECIAL CENTER PC
Entity Type:Organization
Organization Name:NORTHERN MECIAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-238-3800
Mailing Address - Street 1:51 W PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5711
Mailing Address - Country:US
Mailing Address - Phone:732-238-3800
Mailing Address - Fax:732-238-2883
Practice Address - Street 1:51 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5711
Practice Address - Country:US
Practice Address - Phone:732-238-3800
Practice Address - Fax:732-238-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 039611207QG0300X
NJ25MA07937500207R00000X
NJ25MB07663700207R00000X
NJ25MD00274100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ011574OtherGHI
NJ4704191OtherCIGNA
NJ1115857OtherHORIZON
NJ8706808Medicaid
NJ8942404Medicaid
NJP3729381OtherUNITEDHEALTHCARE OXFORD
NJ7024826OtherAETNA
NJA62897Medicare UPIN
NJ7024826OtherAETNA
NJ011574OtherGHI
NJI43072Medicare UPIN
NJF96319Medicare UPIN
NJ901573Medicare ID - Type Unspecified