Provider Demographics
NPI:1346415957
Name:PACIFIC MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PACIFIC MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YASUAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKETSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-943-4040
Mailing Address - Street 1:725 RIVER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1171
Mailing Address - Country:US
Mailing Address - Phone:201-943-4040
Mailing Address - Fax:201-941-4599
Practice Address - Street 1:725 RIVER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1171
Practice Address - Country:US
Practice Address - Phone:201-943-4040
Practice Address - Fax:201-941-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty