Provider Demographics
NPI:1427037217
Name:MONTGOMERY INTERNAL MEDICINE GROUP PC
Entity Type:Organization
Organization Name:MONTGOMERY INTERNAL MEDICINE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-921-6818
Mailing Address - Street 1:727 STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1444
Mailing Address - Country:US
Mailing Address - Phone:609-921-6818
Mailing Address - Fax:609-921-0406
Practice Address - Street 1:727 STATE ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1444
Practice Address - Country:US
Practice Address - Phone:609-921-6818
Practice Address - Fax:609-921-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ002386Medicare PIN