Provider Demographics
NPI:1497075527
Name:MILLVILLE INTERNAL AND SPECIALTY MEDICINE LLC
Entity Type:Organization
Organization Name:MILLVILLE INTERNAL AND SPECIALTY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJEEBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-768-2265
Mailing Address - Street 1:608 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-3025
Mailing Address - Country:US
Mailing Address - Phone:856-825-8080
Mailing Address - Fax:856-327-8571
Practice Address - Street 1:608 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-3025
Practice Address - Country:US
Practice Address - Phone:856-825-8080
Practice Address - Fax:856-327-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07827400207R00000X
FL26MA08374000207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty