| Organization Name: | BRIGANTINE MEDICAL GROUP PA |
| NPI Number: | 1669462735 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARBARA MACKLEER (OFFICE MANAGER) |
| Mailing Address: | 353 12th St S Brigantine |
| State: | NJ US |
| Postal Code: | 082032211 |
| Phone Number: | 6092667557 |
| Fax Number: | 6092664450 |
| NPI Enumeration Date: | 10/28/2005 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | ========= |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |