Organization
MEDALLION CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL LUTZ (EXECUTIVE DIRECTOR)
(609) 443-0404
Entity
Organization
Contact information
Practice address
957 HIGHWAY 33 WEST, SWT 5, MONROE TOWNSHIP, NJ 08831
(609) 443-0404
(609) 443-6394
Mailing address
957 HIGHWAY 33 WEST, SWT 5, MONROE TOWNSHIP, NJ 08831
(609) 443-0404
(609) 443-6394
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6753108
—
NJ
Enumeration date
01/12/2007
Last updated
08/22/2020
Update your record
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