Provider Demographics
NPI:1689722282
Name:MELEIS MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:MELEIS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MELEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-335-0900
Mailing Address - Street 1:233 MIDDLE RD
Mailing Address - Street 2:STE 2
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1958
Mailing Address - Country:US
Mailing Address - Phone:732-335-0900
Mailing Address - Fax:732-335-8080
Practice Address - Street 1:233 MIDDLE RD
Practice Address - Street 2:STE 2
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1958
Practice Address - Country:US
Practice Address - Phone:732-335-0900
Practice Address - Fax:732-335-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ185320Medicare PIN