Basic Information
| Provider Information | |||||||||
| NPI: | 1669591590 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MEGA MEDICAL GROUP | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2637 | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070152637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734734040 | ||||||||
| FaxNumber: | 9734722451 | ||||||||
| Practice Location | |||||||||
| Address1: | 1084 MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070112330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734734040 | ||||||||
| FaxNumber: | 9734722451 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 05/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | BEG | ||||||||
| AuthorizedOfficialFirstName: | MIRZA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9734734040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.