Provider Demographics
NPI:1467835637
Name:UA MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:UA MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OFF BILLING AND REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-719-7168
Mailing Address - Street 1:300 PERRINE RD STE 330
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3629
Mailing Address - Country:US
Mailing Address - Phone:732-719-7168
Mailing Address - Fax:908-300-5152
Practice Address - Street 1:300 PERRINE RD
Practice Address - Street 2:SUITE 333
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857
Practice Address - Country:US
Practice Address - Phone:732-289-9335
Practice Address - Fax:732-289-9336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2022-01-14
Deactivation Date:2021-04-08
Deactivation Code:
Reactivation Date:2022-01-14
Provider Licenses
StateLicense IDTaxonomies
NJ25MA084937002081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ432954Medicare PIN