Provider Demographics
NPI:1700124922
Name:MILLTOWN MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MILLTOWN MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-921-1777
Mailing Address - Street 1:406 MILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2445
Mailing Address - Country:US
Mailing Address - Phone:973-921-1777
Mailing Address - Fax:973-921-1790
Practice Address - Street 1:406 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2445
Practice Address - Country:US
Practice Address - Phone:973-921-1777
Practice Address - Fax:973-921-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA5507600207RP1001X
NJ25MA044565002085R0202X
NJ25MP00211500363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty