Provider Demographics
NPI:1891362364
Name:PATIENT CARE MEDICAL GROUP PC
Entity Type:Organization
Organization Name:PATIENT CARE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:PECORA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-744-0050
Mailing Address - Street 1:26 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3418
Mailing Address - Country:US
Mailing Address - Phone:609-385-2622
Mailing Address - Fax:856-520-8239
Practice Address - Street 1:467 COOPER ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-2519
Practice Address - Country:US
Practice Address - Phone:609-385-2622
Practice Address - Fax:856-520-8239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-04
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB05694000OtherMEDICAL LICENSE NUMBER