Provider Demographics
NPI:1942424783
Name:CHANGEBRIDGE MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:CHANGEBRIDGE MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-575-5540
Mailing Address - Street 1:170 CHANGEBRIDGE RD
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9112
Mailing Address - Country:US
Mailing Address - Phone:973-575-5540
Mailing Address - Fax:975-575-4885
Practice Address - Street 1:170 CHANGEBRIDGE RD.
Practice Address - Street 2:SUITE C-3
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9112
Practice Address - Country:US
Practice Address - Phone:973-575-5540
Practice Address - Fax:973-575-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5655102Medicaid
NJ5655102Medicaid