Provider Demographics
NPI:1578759569
Name:PISCATAWAY MEDICAL GROUP
Entity Type:Organization
Organization Name:PISCATAWAY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-885-1800
Mailing Address - Street 1:17 PLAINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4045
Mailing Address - Country:US
Mailing Address - Phone:732-885-1800
Mailing Address - Fax:732-457-9420
Practice Address - Street 1:17 PLAINFIELD AVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4045
Practice Address - Country:US
Practice Address - Phone:732-885-1800
Practice Address - Fax:732-457-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06056300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070040Medicare PIN
G19669Medicare UPIN