Provider Demographics
NPI:1336245331
Name:MENLA HEALTHCARE LLC
Entity Type:Organization
Organization Name:MENLA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-688-1608
Mailing Address - Street 1:411 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1526
Mailing Address - Country:US
Mailing Address - Phone:609-688-1608
Mailing Address - Fax:609-688-1648
Practice Address - Street 1:411 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1526
Practice Address - Country:US
Practice Address - Phone:609-688-1608
Practice Address - Fax:609-688-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07702800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
090788Medicare PIN