Provider Demographics
NPI:1790025195
Name:SOMERSET MEDICAL CENTER URGENT CARE, PC
Entity Type:Organization
Organization Name:SOMERSET MEDICAL CENTER URGENT CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-685-2200
Mailing Address - Street 1:110 REHILL AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2519
Mailing Address - Country:US
Mailing Address - Phone:908-685-2200
Mailing Address - Fax:908-203-6221
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-685-2200
Practice Address - Fax:908-203-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty