Organization Active NPI

Brigantine Medical Group PA

  • Adult Medicine Physician
  • Brigantine, NJ
National Provider Identifier
1669462735
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
Legal business name
BRIGANTINE MEDICAL GROUP PA
Practice address
353 12TH St S
Brigantine, NJ 08203-2211
Phone
(609) 266-7557
Fax
(609) 266-4450
NPI assigned
Oct 28, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Barbara Mackleer
Title
Office Manager
Phone
(609) 266-7557

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine Physician 207QA0505X NJ Primary

Addresses

Primary practice location

353 12TH St S
Brigantine, NJ 08203-2211

Mailing address

353 12TH St S
Brigantine, NJ 08203-2211
Phone (609) 266-7557

Other identifiers 1

IdentifierTypeStateIssuer
2618907-1MedicaidNJ

National Provider Directory

National Provider Directory

Locations

353 12th St S
Brigantine, NJ 08203
Phone (609) 266-7557

46 W Jimmie Leeds Rd
Galloway, NJ 08205
Phone (609) 404-1099

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1669462735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 12TH ST S",
            "city": "BRIGANTINE",
            "state": "NJ",
            "postal_code": "082032211",
            "telephone_number": "609-266-7557",
            "fax_number": "609-266-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 12TH ST S",
            "city": "BRIGANTINE",
            "state": "NJ",
            "postal_code": "082032211",
            "telephone_number": "609-266-7557",
            "fax_number": "609-266-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIGANTINE MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MACKLEER",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "609-266-7557",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "NJ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2618907-1",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brigantine, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.