| Mylaurel Medical Group Nj, Pc | |
|
400 Morris Ave Ste 224 Denville NJ 07834-1362 | |
| (973) 363-4555 | |
| Not Available |
| Full Name | Mylaurel Medical Group Nj, Pc |
|---|---|
| Speciality | General Practice |
| Location | 400 Morris Ave Ste 224, Denville, New Jersey |
| Authorized Official Name and Position | Leslie Baldridge (CREDENTIALING) |
| Authorized Official Contact | 7024176255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mylaurel Medical Group Nj, Pc 885 3rd Ave Fl 29 New York NY 10022-4834 Ph: () - | Mylaurel Medical Group Nj, Pc 400 Morris Ave Ste 224 Denville NJ 07834-1362 Ph: (973) 363-4555 |
| NPI Number | 1942815295 |
|---|---|
| Provider Enumeration Date | 09/14/2020 |
| Last Update Date | 01/09/2024 |
| Medicare PECOS PAC ID | 3577911189 |
|---|---|
| Medicare Enrollment ID | O20240108005864 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942815295 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Bruce B Bonanno |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275576290 PECOS PAC ID: 1759306293 Enrollment ID: I20051013000310 |
| Provider Name | Gina Grace Puglisi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366472011 PECOS PAC ID: 3375574312 Enrollment ID: I20060503000237 |
| Provider Name | Kimberly Jean Santee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972193183 PECOS PAC ID: 1456767102 Enrollment ID: I20210304001673 |
| Provider Name | Ellen Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235746553 PECOS PAC ID: 3072909696 Enrollment ID: I20220407002735 |
| Provider Name | Esteban P Rojas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518611573 PECOS PAC ID: 7315314408 Enrollment ID: I20221102001482 |
| Provider Name | Jennifer A Reyes |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194258921 PECOS PAC ID: 5496177016 Enrollment ID: I20240111003241 |
| Provider Name | Marcy Gleit Carty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326038928 PECOS PAC ID: 6103844725 Enrollment ID: I20240521004350 |
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