Provider Demographics
NPI:1720415706
Name:LINDEN MEDICAL ASSOCIATES MD PC
Entity Type:Organization
Organization Name:LINDEN MEDICAL ASSOCIATES MD PC
Other - Org Name:ROSELLE PARK MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUHEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-245-9444
Mailing Address - Street 1:331 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-1948
Mailing Address - Country:US
Mailing Address - Phone:908-245-9444
Mailing Address - Fax:908-245-8826
Practice Address - Street 1:331 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-1948
Practice Address - Country:US
Practice Address - Phone:908-245-9444
Practice Address - Fax:908-245-8826
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINDEN MEDICAL ASSOCIATES MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22293207Q00000X
NJ25MA06083100207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0014583Medicaid
NJG4883Medicare UPIN
NJ0014583Medicaid