Provider Demographics
NPI:1740415249
Name:MEDICAL SERVICES PA
Entity Type:Organization
Organization Name:MEDICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMININSTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAUTHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGGINS-PASHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-780-3079
Mailing Address - Street 1:9 LINCOLN PARK
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2301
Mailing Address - Country:US
Mailing Address - Phone:973-242-6599
Mailing Address - Fax:
Practice Address - Street 1:9 LINCOLN PARK
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2301
Practice Address - Country:US
Practice Address - Phone:973-242-6599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07315400208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty