Provider Demographics
NPI:1447445234
Name:CARE STATION MEDICAL GROUP, PA
Entity type:Organization
Organization Name:CARE STATION MEDICAL GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:AGOSTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-925-7519
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-0352
Mailing Address - Country:US
Mailing Address - Phone:908-925-7519
Mailing Address - Fax:908-925-2842
Practice Address - Street 1:328 W SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-5638
Practice Address - Country:US
Practice Address - Phone:908-925-2273
Practice Address - Fax:908-925-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ007845Medicare PIN
6369960003Medicare NSC