Provider Demographics
NPI:1174984967
Name:MC MEDICAL GROUP LLC
Entity type:Organization
Organization Name:MC MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-785-8686
Mailing Address - Street 1:1425 POMPTON AVE
Mailing Address - Street 2:STE 1-1
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-1043
Mailing Address - Country:US
Mailing Address - Phone:973-785-8686
Mailing Address - Fax:973-785-8680
Practice Address - Street 1:1425 POMPTON AVE
Practice Address - Street 2:STE 1-1
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1043
Practice Address - Country:US
Practice Address - Phone:973-785-8686
Practice Address - Fax:973-785-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07840600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty