Provider Demographics
NPI:1851356224
Name:FLEMINGTON MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:FLEMINGTON MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YASMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-782-5100
Mailing Address - Street 1:200 RARITAN COMMONS RTE 31 NORTH
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1154
Mailing Address - Country:US
Mailing Address - Phone:908-782-5100
Mailing Address - Fax:908-782-0290
Practice Address - Street 1:200 RARITAN COMMONS RTE 31 NORTH
Practice Address - Street 2:SUITE 105
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1154
Practice Address - Country:US
Practice Address - Phone:908-782-5100
Practice Address - Fax:908-782-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0087263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3414001Medicaid
NJ3414001Medicaid