1245308402 NPI number — PATRICK J DEMARE M.D. , D.O.

Table of content: PATRICK J DEMARE M.D. , D.O. (NPI 1245308402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245308402 NPI number — PATRICK J DEMARE M.D. , D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMARE
Provider First Name:
PATRICK
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D. , D.O.
Provider Gender Code:
M

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:
1245308402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 ESSEX AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOONTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07005-1115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-686-1915
Provider Business Mailing Address Fax Number:
973-686-1916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 BEAVERBROOK RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
LINCOLN PARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07035-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-696-1087
Provider Business Practice Location Address Fax Number:
973-686-1916
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25MB03247600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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