Basic Information
| Provider Information | |||||||||
| NPI: | 1851356224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FLEMINGTON MEDICAL GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 RARITAN COMMONS RTE 31 NORTH | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088221154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087825100 | ||||||||
| FaxNumber: | 9087820290 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 RARITAN COMMONS RTE 31 NORTH | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088221154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087825100 | ||||||||
| FaxNumber: | 9087820290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 12/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | PERALES | ||||||||
| AuthorizedOfficialFirstName: | YASMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9087825100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0087263 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 3414001 | 05 | NJ | MEDICAID |