Avenel Iselin Medical Group, LLC

Key facts

NPI

1669717864

Entity type

Organization (NPI type 2)

Primary specialty

Non-Pharmacy Dispensing Site 332900000X

License

25MA05991500 (NJ)

Legal business name

AVENEL ISELIN MEDICAL GROUP, LLC

Practice address

400 Gill LN
1
Iselin, NJ 08830-3059

Phone

(732) 404-1580

NPI assigned

Nov 29, 2012

Organization subpart

Yes

Parent organization (as reported)

MEDVANTX, INC.

Authorized official

Name

Kenny Heine

Title

VP Ops

Phone

(858) 964-1506

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

• Avenel Iselin Medical Group, LLC Cardiovascular Disease Physician · Raritan, NJ · NPI 1932771078
  NPD tax ID

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marc Mayer, D.O. Family Medicine Physician · Iselin, NJ · NPI 1720083132
  NPD (past)
• Anjum Tanwir, M.D. Cardiovascular Disease Physician · Union, NJ · NPI 1144320128
  NPD (past)

National Provider Directory

Tax ID family

Avenel Iselin Medical G (2 organizations share this tax ID)

Part of

Tri - State Medical Group Inc

Locations

Specialties & licenses

Addresses

Other names

• AVENEL ISELIN MEDICAL GROUP Doing business as

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All providers in Iselin, NJ · Non-Pharmacy Dispensing Site in New Jersey