Reliance Medical Group, LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

25MA08497400 Issued in NJ

Legal business name

RELIANCE MEDICAL GROUP, LLC

Practice address

4013 Route 9 N
Howell, NJ 07731-4021

Phone

(732) 905-5255

Fax

(732) 905-5266

NPI assigned

Apr 15, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jon M Regis, MD

Title

Owner

Phone

(609) 272-0655

Specialties & licenses 3

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475798400000",
    "number": "1104245349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 N FRANKLIN BLVD",
            "address_2": "2ND FLOOR",
            "city": "PLEASANTVILLE",
            "state": "NJ",
            "postal_code": "082322547",
            "telephone_number": "609-272-0655",
            "fax_number": "609-272-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4013 ROUTE 9 N",
            "city": "HOWELL",
            "state": "NJ",
            "postal_code": "077314021",
            "telephone_number": "732-905-5255",
            "fax_number": "732-905-5266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RELIANCE MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-15",
        "last_updated": "2016-10-07",
        "status": "A",
        "authorized_official_last_name": "REGIS",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-272-0655",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MA07164700",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07968600",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MA08497400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8139504",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Howell, NJ
• Providers in Howell, NJ by specialty
• Geriatric Medicine (Internal Medicine) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.