Provider Demographics
NPI:1679215586
Name:M&R MEDICAL GROUP
Entity Type:Organization
Organization Name:M&R MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-704-6781
Mailing Address - Street 1:14280 S MILITARY TRL UNIT 7838
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33482-5083
Mailing Address - Country:US
Mailing Address - Phone:561-704-6781
Mailing Address - Fax:
Practice Address - Street 1:2300 S BROAD ST STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4462
Practice Address - Country:US
Practice Address - Phone:561-704-6781
Practice Address - Fax:561-209-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty