Provider Demographics
NPI:1831327683
Name:MERCURY MEDICAL MANAGEMENT
Entity type:Organization
Organization Name:MERCURY MEDICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JED
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:732-648-6645
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08836-0011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:213 ELMER STREET
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2304
Practice Address - Country:US
Practice Address - Phone:732-648-6645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies