Provider Demographics
NPI:1437392198
Name:MID ATLANTIC DIABETES AND ENDOCRINOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MID ATLANTIC DIABETES AND ENDOCRINOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-685-2747
Mailing Address - Street 1:555 IRON BRIDGE RD STE 18
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2975
Mailing Address - Country:US
Mailing Address - Phone:732-409-6233
Mailing Address - Fax:
Practice Address - Street 1:555 IRON BRIDGE RD STE 18
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2975
Practice Address - Country:US
Practice Address - Phone:732-409-6233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72694207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty