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PINEBROOK MEDICAL CENTER LLC NPI 1811205024


NPI Information

NPI: 1811205024
Provider Name: PINEBROOK MEDICAL CENTER LLC,
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 31D0993076

Address:
170 CHANGEBRIDGE ROAD
SUITE A-3
MONTVILLE, NJ
ZIP 07045
Phone: (973) 808-3200
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PINEBROOK MEDICAL CENTER LLC, is a primary care clinic center in Montville, NJ. PINEBROOK MEDICAL CENTER LLC, NPI is 1811205024. The provider is registered as an organization entity type.

The provider's business location address is:

170 CHANGEBRIDGE ROAD
SUITE A-3
MONTVILLE, NJ
ZIP 07045
Phone: (973) 808-3200
Fax: (973) 808-3202

The provider's authorized official is Thomas Stack .
The authorized official title is Owner/doctor and has the following contact phone number (973) 808-3200.

The CLIA number assigned to this NPI record is 31D0993076 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/22/2010 and was last updated on 9/22/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareMB58292NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1ST624751MEDICARE PINNEW JERSEY
2F93378MEDICARE UPINNEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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