Organization
RELIANCE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON M REGIS MD (OWNER)
(609) 272-0655
Entity
Organization
Contact information
Practice address
1325 BALTIC AVE, ATLANTIC CITY, NJ 08401-4516
(609) 441-0723
(609) 441-0953
Mailing address
22 N FRANKLIN BLVD, 2ND FLOOR, PLEASANTVILLE, NJ 08232-2547
(609) 272-0655
(609) 272-9317
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25MA07552100
NJ
207R00000X
Internal Medicine Physician
25MA04388900
NJ
208000000X
Pediatrics Physician
25MA03906000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8139504
—
NJ
Enumeration date
08/20/2014
Last updated
08/20/2014
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