Provider Demographics
NPI:1760785398
Name:P & C MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:P & C MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CISNERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-659-0075
Mailing Address - Street 1:530 WESTFIELD AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1623
Mailing Address - Country:US
Mailing Address - Phone:908-659-0075
Mailing Address - Fax:908-459-4300
Practice Address - Street 1:534 WESTFIELD AVE FL 2
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1623
Practice Address - Country:US
Practice Address - Phone:908-659-0075
Practice Address - Fax:908-459-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08784000207Q00000X
207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0253669Medicaid
NJ0253669Medicaid