Provider Demographics
NPI:1639461916
Name:MALCOLM H. HERMELE, M. D., P.A.
Entity Type:Organization
Organization Name:MALCOLM H. HERMELE, M. D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:H
Authorized Official - Last Name:HERMELE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:908-687-7250
Mailing Address - Street 1:2333 MORRIS AVE
Mailing Address - Street 2:SUITE A-117
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5714
Mailing Address - Country:US
Mailing Address - Phone:908-687-7250
Mailing Address - Fax:908-964-0188
Practice Address - Street 1:2333 MORRIS AVE
Practice Address - Street 2:SUITE A-117
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5714
Practice Address - Country:US
Practice Address - Phone:908-687-7250
Practice Address - Fax:908-964-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02501400207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56131Medicare UPIN