Provider Demographics
NPI:1205063633
Name:SOMERSET MEDICAL GROUP
Entity type:Organization
Organization Name:SOMERSET MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:VASANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KACHIRAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-448-1893
Mailing Address - Street 1:3322 RTE 22 STE 806
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-4406
Mailing Address - Country:US
Mailing Address - Phone:908-448-1893
Mailing Address - Fax:
Practice Address - Street 1:3322 RTE 22
Practice Address - Street 2:SUITE806
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3476
Practice Address - Country:US
Practice Address - Phone:908-448-1893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care