Provider Demographics
NPI:1437684651
Name:CENTRAL NEW JERSEY MEDICAL OFFICE, LLC
Entity Type:Organization
Organization Name:CENTRAL NEW JERSEY MEDICAL OFFICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-928-1697
Mailing Address - Street 1:22 OLD SHORT HILLS RD STE 112
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5607
Mailing Address - Country:US
Mailing Address - Phone:732-449-0334
Mailing Address - Fax:
Practice Address - Street 1:22 OLD SHORT HILLS RD STE 112
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5607
Practice Address - Country:US
Practice Address - Phone:732-449-0334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty