Provider Demographics
NPI:1679566756
Name:MORGAN MEDICAL CORP
Entity type:Organization
Organization Name:MORGAN MEDICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF CORPORATE BILLING
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:POZUELOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-873-9895
Mailing Address - Street 1:1455 BROAD ST
Mailing Address - Street 2:FL 4
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3003
Mailing Address - Country:US
Mailing Address - Phone:973-707-1100
Mailing Address - Fax:973-707-1127
Practice Address - Street 1:1905 JESS PARRISH CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2146
Practice Address - Country:US
Practice Address - Phone:888-440-6494
Practice Address - Fax:321-269-2611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORGAN MEDICAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-24
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC 36832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57069602Medicaid
FL57069602Medicaid