| Family Md Llc | |
|
393 Mulberry St Ste 203 Newark NJ 07102-3417 | |
| (201) 733-9222 | |
| (201) 777-7132 |
| Full Name | Family Md Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 393 Mulberry St Ste 203, Newark, New Jersey |
| Authorized Official Name and Position | Magdy F Mahmoud (REGISTERED AGENT) |
| Authorized Official Contact | 9733704000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Md Llc 110 Squire Hill Rd Montclair NJ 07043-2516 Ph: (973) 370-4000 | Family Md Llc 393 Mulberry St Ste 203 Newark NJ 07102-3417 Ph: (201) 733-9222 |
| NPI Number | 1962176479 |
|---|---|
| Provider Enumeration Date | 08/07/2021 |
| Last Update Date | 01/05/2022 |
| Medicare PECOS PAC ID | 9234525197 |
|---|---|
| Medicare Enrollment ID | O20220401002357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962176479 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | Sekuleo Gathers |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1598842098 PECOS PAC ID: 9032214234 Enrollment ID: I20151221000554 |
| Provider Name | Melvin Chan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508271313 PECOS PAC ID: 8527358571 Enrollment ID: I20160602001573 |
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