Provider Demographics
NPI:1952849796
Name:OPTUM MEDICAL CARE OF NEW JERSEY PC
Entity Type:Organization
Organization Name:OPTUM MEDICAL CARE OF NEW JERSEY PC
Other - Org Name:RIVERSIDE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:GAURANG
Authorized Official - Middle Name:RAVAJI
Authorized Official - Last Name:BRAHMBHATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-706-8490
Mailing Address - Street 1:1 HARMON PLZ FL 10
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2803
Mailing Address - Country:US
Mailing Address - Phone:201-636-7233
Mailing Address - Fax:
Practice Address - Street 1:324 PALISADE AVE
Practice Address - Street 2:2ND FL
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-1791
Practice Address - Country:US
Practice Address - Phone:201-479-8600
Practice Address - Fax:201-479-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies