Provider Demographics
NPI:1265268528
Name:BRIGHT HARBOR PRIMARY CARE
Entity type:Organization
Organization Name:BRIGHT HARBOR PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:732-279-7715
Mailing Address - Street 1:687 ATLANTIC CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2548
Mailing Address - Country:US
Mailing Address - Phone:732-349-5550
Mailing Address - Fax:
Practice Address - Street 1:687 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-2548
Practice Address - Country:US
Practice Address - Phone:732-349-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCEAN MENTAL HEALTH SERVICES INC,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ00834400OtherNEW JERSEY DIVISION OF CONSUMER AFFAIRS