Provider Demographics
NPI:1790817633
Name:ACCESS MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:ACCESS MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LON
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:908-704-0100
Mailing Address - Street 1:3322 ROUTE 22
Mailing Address - Street 2:BUILDING #1
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3476
Mailing Address - Country:US
Mailing Address - Phone:908-704-0100
Mailing Address - Fax:908-704-0090
Practice Address - Street 1:3322 US HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3476
Practice Address - Country:US
Practice Address - Phone:908-704-0100
Practice Address - Fax:908-704-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04654000207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ070289Medicare ID - Type Unspecified
NJ4798680001Medicare NSC