Provider Demographics
NPI:1578619508
Name:PREVENTIVE MEDICINE OF NEW JERSEY INC
Entity Type:Organization
Organization Name:PREVENTIVE MEDICINE OF NEW JERSEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MILLENDICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-906-0016
Mailing Address - Street 1:2 LINCOLN HIGHWAY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:732-906-0016
Mailing Address - Fax:732-906-8540
Practice Address - Street 1:2 LINCOLN HIGHWAY
Practice Address - Street 2:SUITE 410
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:732-906-0016
Practice Address - Fax:732-906-8540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA034209002083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME451508Medicare ID - Type Unspecified
C55214Medicare UPIN