Pinebrook Medical Center LLC,

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MB58292 Issued in NJ

Legal business name

PINEBROOK MEDICAL CENTER LLC,

Practice address

170 Changebridge Road
Suite a-3
Montville, NJ 07045

Phone

(973) 808-3200

Fax

(973) 808-3202

NPI assigned

Sep 22, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Stack, D.ONPI 1891808572

Title

Owner/Doctor

Phone

(973) 808-3200

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Thomas J. Stack, D.O.

  • Family Medicine Physician
  • Montville, NJ
  • NPI 1891808572
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1285113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285113600000",
    "number": "1811205024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 CHANGEBRIDGE RD BLDG A3",
            "city": "MONTVILLE",
            "state": "NJ",
            "postal_code": "070458802",
            "telephone_number": "973-808-3200",
            "fax_number": "973-808-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 CHANGEBRIDGE ROAD",
            "address_2": "SUITE A-3",
            "city": "MONTVILLE",
            "state": "NJ",
            "postal_code": "07045",
            "telephone_number": "973-808-3200",
            "fax_number": "973-808-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINEBROOK MEDICAL CENTER LLC,",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-22",
        "last_updated": "2010-09-22",
        "status": "A",
        "authorized_official_last_name": "STACK",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "973-808-3200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "MB58292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Montville, NJ
• Providers in Montville, NJ by specialty
• Primary Care Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.