Provider Demographics
NPI:1356513352
Name:SQUIRE MEDICAL GROUP LLC
Entity type:Organization
Organization Name:SQUIRE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EIDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DACQUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-584-2021
Mailing Address - Street 1:3635 QUAKERBRIDGE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1247
Mailing Address - Country:US
Mailing Address - Phone:609-586-1777
Mailing Address - Fax:609-586-0058
Practice Address - Street 1:2279 STATE HIGHWAY 33
Practice Address - Street 2:SUITE 505
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-1750
Practice Address - Country:US
Practice Address - Phone:609-689-6949
Practice Address - Fax:609-689-6999
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FINCH HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05298400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty