| Pinebrook Medical Center Llc, | |
|
170 Changebridge Road Suite A-3 Montville NJ 07045 | |
| (973) 808-3200 | |
| (973) 808-3202 |
| Full Name | Pinebrook Medical Center Llc, |
|---|---|
| Speciality | Clinic/Center |
| Location | 170 Changebridge Road, Montville, New Jersey |
| Authorized Official Name and Position | Thomas Stack (OWNER/DOCTOR) |
| Authorized Official Contact | 9738083200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pinebrook Medical Center Llc, 170 Changebridge Rd Bldg A3 Montville NJ 07045-8802 Ph: (973) 808-3200 | Pinebrook Medical Center Llc, 170 Changebridge Road Suite A-3 Montville NJ 07045 Ph: (973) 808-3200 |
| NPI Number | 1811205024 |
|---|---|
| Provider Enumeration Date | 09/22/2010 |
| Last Update Date | 09/22/2010 |
| Medicare PECOS PAC ID | 8224221874 |
|---|---|
| Medicare Enrollment ID | O20101015000220 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811205024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MB58292 (New Jersey) | Primary |
| Provider Name | Thomas Joseph Stack |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891808572 PECOS PAC ID: 9133312788 Enrollment ID: I20101015000259 |
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