Provider Demographics
NPI:1538158779
Name:MIDDLESEX MEDICAL GROUP
Entity type:Organization
Organization Name:MIDDLESEX MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-661-2020
Mailing Address - Street 1:225 MAY ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3266
Mailing Address - Country:US
Mailing Address - Phone:732-661-2020
Mailing Address - Fax:732-661-2022
Practice Address - Street 1:225 MAY ST
Practice Address - Street 2:SUITE E
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3266
Practice Address - Country:US
Practice Address - Phone:732-661-2020
Practice Address - Fax:732-661-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8325804Medicaid
NJ875781Medicare ID - Type UnspecifiedGROUP NUMBER