Basic Information
Provider Information
NPI: 1184643132
EntityType: 2
ReplacementNPI:  
OrganizationName: MEDEMERGE P.A.
LastName:  
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Mailing Information
Address1: PO BOX 890
Address2:  
City: GREEN BROOK
State: NJ
PostalCode: 088122619
CountryCode: US
TelephoneNumber: 7329688900
FaxNumber: 7329684898
Practice Location
Address1: 1005 N. WASHINGTON AVE
Address2:  
City: GREEN BROOK
State: NJ
PostalCode: 088122619
CountryCode: US
TelephoneNumber: 7329688900
FaxNumber: 7329684898
Other Information
ProviderEnumerationDate: 07/19/2006
LastUpdateDate: 01/03/2012
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: PILLA
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName: D.
AuthorizedOfficialTitleorPosition: DIRECTOR
AuthorizedOfficialTelephone: 7329688900
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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