Provider Demographics
NPI:1134399447
Name:NJR HEALTHCARE PC
Entity type:Organization
Organization Name:NJR HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAUSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-335-3072
Mailing Address - Street 1:1616 PACIFIC AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-6939
Mailing Address - Country:US
Mailing Address - Phone:609-498-7220
Mailing Address - Fax:185-527-1739
Practice Address - Street 1:1616 PACIFIC AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-6939
Practice Address - Country:US
Practice Address - Phone:609-498-7220
Practice Address - Fax:185-527-1739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07168000261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0111031Medicaid
NJ103648Medicare PIN
NJ0111031Medicaid