Provider Demographics
NPI:1912163486
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 MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA MARIE
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:2008-08-04
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06359800207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG42242Medicare UPIN