Provider Demographics
NPI:1861639981
Name:METRO MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:METRO MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-855-9006
Mailing Address - Street 1:870, GREEN STREET
Mailing Address - Street 2:METRO MEDICAL ASSOCIATES.
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2102
Mailing Address - Country:US
Mailing Address - Phone:732-855-9006
Mailing Address - Fax:
Practice Address - Street 1:870 GREEN ST
Practice Address - Street 2:METRO MEDICAL ASSOCIATES.LLC
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2102
Practice Address - Country:US
Practice Address - Phone:732-855-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05402600207R00000X
261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
440344Medicare PIN