Provider Demographics
NPI:1861842692
Name:NGM MANGEMENT COMPANY LLC
Entity Type:Organization
Organization Name:NGM MANGEMENT COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MELILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-906-0091
Mailing Address - Street 1:106 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3945
Mailing Address - Country:US
Mailing Address - Phone:732-906-0091
Mailing Address - Fax:732-906-0249
Practice Address - Street 1:106 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3945
Practice Address - Country:US
Practice Address - Phone:732-906-0091
Practice Address - Fax:732-906-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03774600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC52805Medicare UPIN