Provider Demographics
NPI:1548370331
Name:DOCTORS MEDI CENTER P.A.
Entity type:Organization
Organization Name:DOCTORS MEDI CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-969-2240
Mailing Address - Street 1:835 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-1815
Mailing Address - Country:US
Mailing Address - Phone:732-969-2240
Mailing Address - Fax:732-969-2152
Practice Address - Street 1:835 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-1815
Practice Address - Country:US
Practice Address - Phone:732-969-2240
Practice Address - Fax:732-969-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA039357207X00000X
NJMA001728213E00000X
NJMA038121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1123870001Medicare NSC
C58280Medicare UPIN
NJ527891Medicare PIN
C54226Medicare UPIN
T45068Medicare UPIN
H55001Medicare UPIN