Provider Demographics
NPI:1619046018
Name:MIDLAND MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MIDLAND MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CABALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-333-4115
Mailing Address - Street 1:2726 KENNEDY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5508
Mailing Address - Country:US
Mailing Address - Phone:201-333-4115
Mailing Address - Fax:201-333-6224
Practice Address - Street 1:2726 KENNEDY BOULEVARD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5508
Practice Address - Country:US
Practice Address - Phone:201-333-4115
Practice Address - Fax:201-333-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05783300170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty