Provider Demographics
NPI:1457602823
Name:ADVANCED MEDICAL OF CENTRAL JERSEY,LLC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL OF CENTRAL JERSEY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDRED
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-654-1500
Mailing Address - Street 1:2253 SOUTH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-4688
Mailing Address - Country:US
Mailing Address - Phone:908-654-1500
Mailing Address - Fax:
Practice Address - Street 1:2253 SOUTH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-4688
Practice Address - Country:US
Practice Address - Phone:908-654-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06695100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty