Provider Demographics
NPI:1033970025
Name:RIPPL CARE PC OF NEW JERSEY, PC
Entity Type:Organization
Organization Name:RIPPL CARE PC OF NEW JERSEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN REKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-647-1007
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-0352
Mailing Address - Country:US
Mailing Address - Phone:206-647-1007
Mailing Address - Fax:
Practice Address - Street 1:2825 EASTLAKE AVE E STE 230
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3013
Practice Address - Country:US
Practice Address - Phone:206-647-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health