Provider Demographics
NPI:1770632879
Name:R M C N J PA
Entity Type:Organization
Organization Name:R M C N J PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOV
Authorized Official - Middle Name:JOHANAN
Authorized Official - Last Name:RAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-731-8112
Mailing Address - Street 1:667 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2177
Mailing Address - Country:US
Mailing Address - Phone:973-731-8112
Mailing Address - Fax:
Practice Address - Street 1:667 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2177
Practice Address - Country:US
Practice Address - Phone:973-731-8112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05832500225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5444128OtherAETNA PIN
NJ6543006Medicaid
P2823540OtherOXFORD PIN
5444128OtherAETNA PIN
NJ6543006Medicaid