MD Medical Group

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

MD MEDICAL GROUP

Practice address

68 1St Ave Ste C
Atlantic Highlands, NJ 07716-1288

Phone

(908) 309-5992

NPI assigned

Mar 23, 2021

Last updated

Mar 25, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Wickersham

Title

Jr Member

Phone

(908) 309-5992

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616630400000",
    "number": "1982280426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 1ST AVE STE C",
            "city": "ATLANTIC HIGHLANDS",
            "state": "NJ",
            "postal_code": "077161288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 1ST AVE STE C",
            "city": "ATLANTIC HIGHLANDS",
            "state": "NJ",
            "postal_code": "077161288",
            "telephone_number": "908-309-5992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MD MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-23",
        "last_updated": "2021-03-25",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "WICKERSHAM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "JR MEMBER",
        "authorized_official_telephone_number": "908-309-5992"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erolina Matthews
• Ariel Renee Mayer, PHARMD
• John Joseph Mazzella, D.C.
• Lisa McCarthy, AGNP
• Shayne McKinsey, PH.D., LPC
• Nicole Marie Mednis, LSW
• Kathleen Mickel, APN, RN
• Elizabeth Milewski, PTA
• Joseph Louis Monaco, PA-C
• Tara Moran, LCSW LCADC

• Specialist in Atlantic Highlands, NJ
• Providers in Atlantic Highlands, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2021; 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.