Provider Demographics
NPI:1396749354
Name:SOMERSET MEDICAL ASSOCIATES PA
Entity type:Organization
Organization Name:SOMERSET MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-846-3385
Mailing Address - Street 1:PO BOX 8500-3240
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:732-730-3615
Mailing Address - Fax:732-730-3619
Practice Address - Street 1:1553 HIGHWAY 27
Practice Address - Street 2:3100
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3993
Practice Address - Country:US
Practice Address - Phone:732-846-3385
Practice Address - Fax:732-846-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ670399Medicare UPIN