Provider Demographics
NPI:1770562993
Name:MACH, PHILIP (MD, FCCP)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:MACH
Suffix:
Gender:M
Credentials:MD, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4058
Mailing Address - Country:US
Mailing Address - Phone:908-241-2030
Mailing Address - Fax:
Practice Address - Street 1:123 DUNHAMS CORNER RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3532
Practice Address - Country:US
Practice Address - Phone:732-254-9474
Practice Address - Fax:732-254-5509
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA051888207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ610687UN0Medicare ID - Type UnspecifiedPROVIDER #
NJE55090Medicare UPIN
NJ095080Medicare ID - Type UnspecifiedGROUP #