Provider Demographics
NPI:1982014791
Name:JMD FAMILY PRACTICE, L.L.C
Entity Type:Organization
Organization Name:JMD FAMILY PRACTICE, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-788-7846
Mailing Address - Street 1:2 KINGS CT STE 203
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-6019
Mailing Address - Country:US
Mailing Address - Phone:908-751-5439
Mailing Address - Fax:908-751-5478
Practice Address - Street 1:2 KINGS CT STE 203
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-6019
Practice Address - Country:US
Practice Address - Phone:908-751-5439
Practice Address - Fax:908-751-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA05652500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6274102Medicaid
NJ6274102Medicaid