Provider Demographics
NPI:1265517445
Name:ENDOCRINE MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:ENDOCRINE MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-267-9099
Mailing Address - Street 1:25 LINDSLEY DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4455
Mailing Address - Country:US
Mailing Address - Phone:973-267-9099
Mailing Address - Fax:973-605-5960
Practice Address - Street 1:25 LINDSLEY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4455
Practice Address - Country:US
Practice Address - Phone:973-267-9099
Practice Address - Fax:973-605-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTIN
NJ017936Medicare ID - Type UnspecifiedPROVIDER GROUP ID