Provider Demographics
NPI:1639146277
Name:ID CARE LLC
Entity Type:Organization
Organization Name:ID CARE LLC
Other - Org Name:ID ASSOCIATES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:NAHASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-281-0221
Mailing Address - Street 1:105 RAIDER BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1528
Mailing Address - Country:US
Mailing Address - Phone:908-281-0221
Mailing Address - Fax:908-281-0890
Practice Address - Street 1:105 RAIDER BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-1528
Practice Address - Country:US
Practice Address - Phone:908-281-0221
Practice Address - Fax:908-281-0890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4619501Medicaid
NJ4619501Medicaid
NJ679077Medicare ID - Type Unspecified