Provider Demographics
NPI:1336212000
Name:NEIGHBORHOOD MEDICAL CARE LLC
Entity Type:Organization
Organization Name:NEIGHBORHOOD MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-841-2041
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:CONVENT STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:07961-0149
Mailing Address - Country:US
Mailing Address - Phone:201-841-2041
Mailing Address - Fax:973-359-8979
Practice Address - Street 1:290 MADISON AVE
Practice Address - Street 2:2A
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7400
Practice Address - Country:US
Practice Address - Phone:973-285-1999
Practice Address - Fax:973-359-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04108000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherEIN