Provider Demographics
NPI:1114975257
Name:INTERNAL MEDICINE FACULTY PRACTICE ASSOCIATES AT ST BARNABAS MED CTR
Entity Type:Organization
Organization Name:INTERNAL MEDICINE FACULTY PRACTICE ASSOCIATES AT ST BARNABAS MED CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:AHEARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-557-7119
Mailing Address - Street 1:PO BOX 18313
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07191-8313
Mailing Address - Country:US
Mailing Address - Phone:732-557-7160
Mailing Address - Fax:732-557-7109
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1000
Practice Address - Country:US
Practice Address - Phone:973-322-6256
Practice Address - Fax:973-322-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6462901Medicaid
NJ644855Medicare ID - Type UnspecifiedGROUP