| Glutality Provider Group Of New Jersey, Pa. | |
|
3600 Route 66 Ste 150 Neptune NJ 07753-2645 | |
| (561) 678-2026 | |
| Not Available |
| Full Name | Glutality Provider Group Of New Jersey, Pa. |
|---|---|
| Speciality | Internal Medicine |
| Location | 3600 Route 66 Ste 150, Neptune, New Jersey |
| Authorized Official Name and Position | Mark Mitchell (OWNER) |
| Authorized Official Contact | 5616782026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glutality Provider Group Of New Jersey, Pa. 401 Fairway Dr Ste 200 Deerfield Beach FL 33441-1800 Ph: (561) 678-2026 | Glutality Provider Group Of New Jersey, Pa. 3600 Route 66 Ste 150 Neptune NJ 07753-2645 Ph: (561) 678-2026 |
| NPI Number | 1396335675 |
|---|---|
| Provider Enumeration Date | 01/21/2021 |
| Last Update Date | 11/08/2021 |
| Medicare PECOS PAC ID | 1759790793 |
|---|---|
| Medicare Enrollment ID | O20210504002149 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396335675 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Daniel Gerard Funsch |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023471547 PECOS PAC ID: 2365789039 Enrollment ID: I20200205001417 |
| Provider Name | Mark Mitchell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003833633 PECOS PAC ID: 2264333632 Enrollment ID: I20210504002218 |
| Provider Name | Sachin Parekh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285749952 PECOS PAC ID: 6204832314 Enrollment ID: I20210507001051 |
| Provider Name | Hosam Atoom |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336593706 PECOS PAC ID: 4284069535 Enrollment ID: I20210621003508 |
| Provider Name | Tiffani Dawn Lemen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760651210 PECOS PAC ID: 1355472671 Enrollment ID: I20230508002487 |
| Provider Name | Ana Lisa Carr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689841744 PECOS PAC ID: 2567741580 Enrollment ID: I20230522001162 |
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