Provider Demographics
NPI:1982631388
Name:PRIMARY CARE NETWORK AT RARITAN BAY INC
Entity Type:Organization
Organization Name:PRIMARY CARE NETWORK AT RARITAN BAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILPERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-818-9118
Mailing Address - Street 1:PO BOX 48277
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4800
Mailing Address - Country:US
Mailing Address - Phone:201-818-9118
Mailing Address - Fax:
Practice Address - Street 1:466 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3647
Practice Address - Country:US
Practice Address - Phone:732-324-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07867800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2682252000OtherPEDS AMERIHEALTH GROUP #
NJ7141058OtherPEDS AETNA PPO GROUP #
NJ8219701OtherPEDS GHI PPO GROUP #
NJ0707547OtherPEDS AETNA HMO GROUP #
NJ8219701OtherIM GHI PPO GROUP #
NJ=========OtherIM / PED'S TAX ID #