Organization
OLD HOOK MEDICAL ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA MONTECILLO (CREDENTIALING MANAGER)
(201) 666-3900
Entity
Organization
Contact information
Practice address
452 OLD HOOK RD, 2ND FLOOR, EMERSON, NJ 07630-1381
(201) 666-3900
(201) 261-0505
Mailing address
452 OLD HOOK RD, 2ND FLOOR, EMERSON, NJ 07630-1381
(201) 666-3900
(201) 261-0505
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1092980
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG1156
RAIL ROAD MEDICARE
—
Enumeration date
06/09/2006
Last updated
09/10/2014
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