Provider Demographics
NPI:1811408172
Name:BMG NEWARK LLC
Entity Type:Organization
Organization Name:BMG NEWARK LLC
Other - Org Name:BLUE STAR URGENT CARE & WALK-IN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAGDY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-370-4000
Mailing Address - Street 1:110 SQUIRE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2516
Mailing Address - Country:US
Mailing Address - Phone:973-370-4000
Mailing Address - Fax:862-904-0044
Practice Address - Street 1:794 MOUNT PROSPECT AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3221
Practice Address - Country:US
Practice Address - Phone:973-370-4444
Practice Address - Fax:973-370-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QU0200X
NJ25MA08818300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0263273Medicaid