Provider Demographics
NPI:1447378435
Name:MOUNTAINVIEW MEDICAL GROUP PC
Entity type:Organization
Organization Name:MOUNTAINVIEW MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-337-1700
Mailing Address - Street 1:9 POST RD
Mailing Address - Street 2:SUITE D7
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-1618
Mailing Address - Country:US
Mailing Address - Phone:201-337-1700
Mailing Address - Fax:201-337-1703
Practice Address - Street 1:9 POST RD
Practice Address - Street 2:SUITE D7
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-1618
Practice Address - Country:US
Practice Address - Phone:201-337-1700
Practice Address - Fax:201-337-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8107009Medicaid
NJH08086Medicare UPIN
NJ034276Medicare ID - Type Unspecified