Provider Demographics
NPI:1669640470
Name:GERICARE ASSOCIATES
Entity Type:Organization
Organization Name:GERICARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACQUAROLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-429-7600
Mailing Address - Street 1:1305 N. KINGS HIGHWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-429-7600
Mailing Address - Fax:856-429-7130
Practice Address - Street 1:1305 N KINGS HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-1919
Practice Address - Country:US
Practice Address - Phone:856-429-7600
Practice Address - Fax:856-429-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05722900207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0150746Medicaid
NJ107601Medicare PIN