Provider Demographics
NPI:1922177070
Name:PENNINGTON MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:PENNINGTON MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIGAHUS
Authorized Official - Middle Name:
Authorized Official - Last Name:KARABULUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-737-7424
Mailing Address - Street 1:820 BEAR TAVERN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-1021
Mailing Address - Country:US
Mailing Address - Phone:607-737-7424
Mailing Address - Fax:609-882-5224
Practice Address - Street 1:820 BEAR TAVERN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-1021
Practice Address - Country:US
Practice Address - Phone:607-737-7424
Practice Address - Fax:609-882-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID