Basic Information
| Provider Information | |||||||||
| NPI: | 1235361833 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRST CARE MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 VALLEY BROOK AVE | ||||||||
| Address2: | |||||||||
| City: | LYNDHURST | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070711301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018960900 | ||||||||
| FaxNumber: | 2018962726 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 VALLEY BROOK AVE | ||||||||
| Address2: | |||||||||
| City: | LYNDHURST | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070711301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018960900 | ||||||||
| FaxNumber: | 2018962726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2009 | ||||||||
| LastUpdateDate: | 08/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | AMBROSIO | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9738578995 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.