Provider Demographics
NPI:1477640159
Name:NJR HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:NJR HEALTHCARE, P.C.
Other - Org Name:DR. ALAN H. FAUSTINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:FAUSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-374-2960
Mailing Address - Street 1:406 ROCKBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6013
Mailing Address - Country:US
Mailing Address - Phone:800-374-2960
Mailing Address - Fax:609-927-9121
Practice Address - Street 1:406 ROCKBRIDGE CT
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-6013
Practice Address - Country:US
Practice Address - Phone:800-374-2960
Practice Address - Fax:609-927-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07168208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0111031Medicaid
NJ0111031Medicaid