Provider Demographics
NPI:1326356197
Name:RARITAN BAY MEDICAL CENTER
Entity Type:Organization
Organization Name:RARITAN BAY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-324-3300
Mailing Address - Street 1:PO BOX 48270
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-8470
Mailing Address - Country:US
Mailing Address - Phone:201-818-9118
Mailing Address - Fax:732-952-8841
Practice Address - Street 1:466 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3647
Practice Address - Country:US
Practice Address - Phone:732-324-3300
Practice Address - Fax:732-952-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05881000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4137817Medicaid