Provider Demographics
NPI:1023142718
Name:MERCER MEDICAL GROUP LLC
Entity type:Organization
Organization Name:MERCER MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRITI
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDYA-PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-347-5282
Mailing Address - Street 1:2477 ROUTE 516 STE 202
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4603
Mailing Address - Country:US
Mailing Address - Phone:732-365-2600
Mailing Address - Fax:732-909-2572
Practice Address - Street 1:2477 ROUTE 516 STE 202
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-4603
Practice Address - Country:US
Practice Address - Phone:732-365-2600
Practice Address - Fax:732-909-2572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ111494OtherBLUE CROSS BLUE SHIELD