Provider Demographics
NPI:1366639361
Name:RAE MEDICAL LLC
Entity Type:Organization
Organization Name:RAE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-623-4957
Mailing Address - Street 1:186 W MARKET ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2783
Mailing Address - Country:US
Mailing Address - Phone:973-623-4957
Mailing Address - Fax:973-623-2103
Practice Address - Street 1:186 W MARKET ST
Practice Address - Street 2:SUITE 113
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2783
Practice Address - Country:US
Practice Address - Phone:973-623-4957
Practice Address - Fax:973-623-2103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07844500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty