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BRIDGEWATER MEDICAL GROUP
NPI 1255752044
Non-Pharmacy Dispensing Site in Bridgewater, NJ

Active since December 20, 2013CLIA 31D0123829 · Waiver
766 US HIGHWAY 202/206, BRIDGEWATER, NJ 08807(908) 722-0808 Get Directions Write a Review

NPPES record last updated: December 20, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Bridgewater Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRIDGEWATER MEDICAL GROUP (NPI 1255752044) is a healthcare organization registered as a non-pharmacy dispensing site in Bridgewater, New Jersey and active in the NPI registry since December 2013. The organization holds a CLIA Waiver certificate valid through December 22, 2027 and lists Kenny Heine, Vp Of Operations, as its authorized official.

NPPES Registry Identity

NPI1255752044
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameBRIDGEWATER MEDICAL GROUP PA
Location Address766 US HIGHWAY 202/206Bridgewater, NJ 08807-1777
Mailing Address5626 Oberlin Dr, Suite 110San Diego, CA 92121-1705
Phone(908) 722-0808
Organization SubpartYesParent: Medvantx
Authorized OfficialKenny HeineVp Of Operations · (858) 964-1506
Enumeration DateDecember 20, 2013
✔ NPI 1255752044 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
License✔ Licensed in NJ · 25MB05436000
Definition
A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
766 US HIGHWAY 202/206, Bridgewater, NJ 08807
Open in Google Maps ↗

Other Names 1

Doing Business AsBridgewater Medical Group

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 31D0123829

Bridgewater Medical Group · Bridgewater, NJ
Active · expires Dec 22, 2027
CLIA Number31D0123829
Laboratory TypePhysician Office
Certificate Effective DateDecember 23, 2025
Certificate Expiration DateDecember 22, 2027
Laboratory DirectorRobert Lustig Do
Laboratory Phone(908) 722-0808
Laboratory LocationBridgewater Medical Group766 Rte 202-206 N Suite 1, Bridgewater, NJ 08807
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JEANNE MITTERANDO M.D.
Family Medicine
766 US HIGHWAY 202/206, SUITE ONE
BRIDGEWATER, NJ 08807
Somerset County (908) 722-0808
MS. MICHELE M TERRONI PA-C
Physician Assistant
766 US HIGHWAY 202/206, SUITE 1
BRIDGEWATER, NJ 08807
Somerset County (908) 722-0808

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bridgewater Medical Group PA's NPI number?

The NPI number for Bridgewater Medical Group PA is 1255752044. It was assigned to this organization in the NPPES registry on December 20, 2013. The provider is doing business as Bridgewater Medical Group.

Where is Bridgewater Medical Group PA located?

Bridgewater Medical Group PA is located at 766 Us Highway 202/206, Bridgewater, NJ 08807. The listed phone number is (908) 722-0808.

What is Bridgewater Medical Group PA's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

Does Bridgewater Medical Group PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 31D0123829) is associated with this NPI, valid through December 22, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Bridgewater Medical Group PA was last updated on December 20, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.