Provider Demographics
NPI:1316230402
Name:PATRICK J DEMARE DO, PA
Entity Type:Organization
Organization Name:PATRICK J DEMARE DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEMARE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-696-1087
Mailing Address - Street 1:63 BEAVERBROOK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1440
Mailing Address - Country:US
Mailing Address - Phone:973-696-1087
Mailing Address - Fax:973-686-1916
Practice Address - Street 1:63 BEAVERBROOK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1440
Practice Address - Country:US
Practice Address - Phone:973-696-1087
Practice Address - Fax:973-686-1916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03247600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty