1306954243 NPI number — RARITAN BAY MEDICAL CENTER

Table of content: (NPI 1306954243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306954243 NPI number — RARITAN BAY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RARITAN BAY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306954243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11665
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07101-4665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-293-2314
Provider Business Mailing Address Fax Number:
732-952-8841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 NEW BRUNSWICK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERTH AMBOY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08861-3654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-293-2314
Provider Business Practice Location Address Fax Number:
732-952-8841
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAILPERIN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGED CARE
Authorized Official Telephone Number:
732-293-2314

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0105X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0001431 . This is a "NEO GHI PPO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: DD0800 . This is a "SURGERY RRMDCR GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0001431 . This is a "SURGERY GHI PPO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0013003 . This is a "FP AETNA HMO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2697433000 . This is a "OBGYN AMERIHEALTH GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4137809 . This is a "BRUG HEALTHSTART MEDICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6420530 . This is a "FP AETNA PPO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0013003 . This is a "NEO AETNA HMO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0004310000 . This is a "NEO AMERIHEALTH GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: DD0800 . This is a "PATH RRMDCR GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7314162 . This is a "NEO AETNA PPO GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0004310000 . This is a "PATH AMERIHEALTH GROUP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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