Provider Demographics
NPI:1659423549
Name:PEMCARE LLC
Entity Type:Organization
Organization Name:PEMCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MISKO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:732-287-6004
Mailing Address - Street 1:267 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1269
Mailing Address - Country:US
Mailing Address - Phone:732-287-6004
Mailing Address - Fax:732-287-3575
Practice Address - Street 1:267 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1269
Practice Address - Country:US
Practice Address - Phone:732-287-6004
Practice Address - Fax:732-287-3575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA62917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1737406OtherUNITED HEALTHCARE
2596853OtherGHI
P1934612OtherOXFORD
40049OtherMEDICHOICE
0744764001OtherAMERIHEALTH HMO POS
4H8791OtherWELLCHOICE
8637489OtherCIGNA
0462541000OtherAMERIHEALTH PPO
1734357OtherFIRST HEALTH
2185368OtherAETNA
J7960OtherHORIZON HMO POS
1K2138OtherHEALTHNET
23641OtherAETNA CAP
31832OtherMASTERCARE
40049OtherMEDICHOICE