Provider Demographics
NPI:1659882082
Name:BMG EAST ORANGE LLC
Entity Type:Organization
Organization Name:BMG EAST ORANGE LLC
Other - Org Name:URGENT CARE & WALK-IN MEDICAL SUITE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING & CREDENTIALING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BLIMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIAL
Authorized Official - Phone:845-662-2404
Mailing Address - Street 1:200 FREEWAY DR E STE 305
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-3809
Mailing Address - Country:US
Mailing Address - Phone:973-370-4000
Mailing Address - Fax:862-904-0044
Practice Address - Street 1:200 FREEWAY DR E STE 305
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-370-4000
Practice Address - Fax:973-370-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08818300207R00000X, 207RI0200X
261QU0200X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0630390Medicaid
NJ0630390Medicaid