Organization
MENLO PARK MEDICAL GROUP P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE CREIGHTON (OFFICE MANAGER)
(732) 549-2299
Entity
Organization
Contact information
Practice address
111 JAMES STREET, EDISON, NJ 08820-3967
(732) 549-2299
(732) 549-2262
Mailing address
111 JAMES STREET, EDISON, NJ 08820-3967
(732) 549-2299
(732) 549-2262
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2627809
—
NJ
Enumeration date
07/24/2006
Last updated
08/08/2023
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