| Loyal Medical Pc | |
|
1000 Edgewood Ln Fort Lee NJ 07024-4223 | |
| (201) 886-8188 | |
| (201) 886-8288 |
| Full Name | Loyal Medical Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1000 Edgewood Ln, Fort Lee, New Jersey |
| Authorized Official Name and Position | Matsuko Takeshige (PRESIDENT) |
| Authorized Official Contact | 2018868818 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Loyal Medical Pc 1000 Edgewood Ln Fort Lee NJ 07024-4223 Ph: (201) 886-8188 | Loyal Medical Pc 1000 Edgewood Ln Fort Lee NJ 07024-4223 Ph: (201) 886-8188 |
| NPI Number | 1366833352 |
|---|---|
| Provider Enumeration Date | 02/11/2015 |
| Last Update Date | 06/22/2015 |
| Medicare PECOS PAC ID | 5698086411 |
|---|---|
| Medicare Enrollment ID | O20230330002573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366833352 | NPI | - | NPPES |
| 0460931 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 25MB09434100 (New Jersey) | Primary |
| Provider Name | Matsuko Takeshige |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285794925 PECOS PAC ID: 9335159862 Enrollment ID: I20060428000133 |
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