Provider Demographics
NPI:1518231190
Name:UMDNJ-RWJMS FAMILY MEDICINE
Entity Type:Organization
Organization Name:UMDNJ-RWJMS FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADITY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATTACHARYYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-815-2671
Mailing Address - Street 1:433 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-4514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:433 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4514
Practice Address - Country:US
Practice Address - Phone:609-815-2671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty