| Reformed Church House Staff | |
|
1990 State Route 18 Old Bridge NJ 08857-3771 | |
| (732) 607-9230 | |
| (732) 607-9231 |
| Full Name | Reformed Church House Staff |
|---|---|
| Speciality | Family Medicine |
| Location | 1990 State Route 18, Old Bridge, New Jersey |
| Authorized Official Name and Position | Edward Mezic (PHYSICIAN) |
| Authorized Official Contact | 7323493838 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Reformed Church House Staff Po Box 1247 Toms River NJ 08754-1247 Ph: () - | Reformed Church House Staff 1990 State Route 18 Old Bridge NJ 08857-3771 Ph: (732) 607-9230 |
| NPI Number | 1508072745 |
|---|---|
| Provider Enumeration Date | 05/15/2007 |
| Last Update Date | 10/04/2018 |
| Medicare PECOS PAC ID | 4587707112 |
|---|---|
| Medicare Enrollment ID | O20120706000109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508072745 | NPI | - | NPPES |
| 4477511 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Edward T Mezic |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1437218435 PECOS PAC ID: 9335133792 Enrollment ID: I20071127000541 |
| Provider Name | Grace Elizabeth Brunner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235560285 PECOS PAC ID: 5092934406 Enrollment ID: I20170330002627 |
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