Provider Demographics
NPI:1245308402
Name:DEMARE, PATRICK J (MD , DO)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:DEMARE
Suffix:
Gender:M
Credentials:MD , DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:127 ESSEX AVE
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-1115
Mailing Address - Country:US
Mailing Address - Phone:973-686-1915
Mailing Address - Fax:973-686-1916
Practice Address - Street 1:63 BEAVERBROOK RD
Practice Address - Street 2:STE 101
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1440
Practice Address - Country:US
Practice Address - Phone:973-696-1087
Practice Address - Fax:973-686-1916
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03247600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53474Medicare UPIN
NJ452613Medicare ID - Type UnspecifiedMEDICARE