Provider Demographics
NPI:1568421600
Name:MID JERSEY RESP. ASSOCIATES, MEDICAL SUPPLIES & CLINICAL SVCS., INC
Entity Type:Organization
Organization Name:MID JERSEY RESP. ASSOCIATES, MEDICAL SUPPLIES & CLINICAL SVCS., INC
Other - Org Name:MJRA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:GONZALEZ-GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, CFO
Authorized Official - Phone:732-721-0028
Mailing Address - Street 1:106 1/2 N BROADWAY
Mailing Address - Street 2:BOX 98
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1706
Mailing Address - Country:US
Mailing Address - Phone:732-721-0028
Mailing Address - Fax:732-721-0008
Practice Address - Street 1:106 1/2 N BROADWAY
Practice Address - Street 2:BOX 98
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1706
Practice Address - Country:US
Practice Address - Phone:732-721-0028
Practice Address - Fax:732-721-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ43ZA00010300332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010002125-00OtherAMERICHOICE OF NJ
NJ575943OtherAETNA
NJ6400001Medicaid
NJ0099287Medicaid
NJ0099287Medicaid