Provider Demographics
NPI:1073775375
Name:RARITAN BAY INFECTIOUS DISEASES CONSULTANTS,PA
Entity Type:Organization
Organization Name:RARITAN BAY INFECTIOUS DISEASES CONSULTANTS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-360-2700
Mailing Address - Street 1:3 HOSPITAL PLZ
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3093
Mailing Address - Country:US
Mailing Address - Phone:732-360-2700
Mailing Address - Fax:732-360-2703
Practice Address - Street 1:3 HOSPITAL PLZ
Practice Address - Street 2:SUITE 208
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3093
Practice Address - Country:US
Practice Address - Phone:732-360-2700
Practice Address - Fax:732-360-2703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA28183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1777203Medicaid