Provider Demographics
NPI:1396736864
Name:REGIONAL PHYSICIAN SERVICES, NJ, PC
Entity type:Organization
Organization Name:REGIONAL PHYSICIAN SERVICES, NJ, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-328-0312
Mailing Address - Street 1:PARK 80 WEST, PLAZA II
Mailing Address - Street 2:SUITE 200, #2061
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5836
Mailing Address - Country:US
Mailing Address - Phone:866-662-4560
Mailing Address - Fax:877-279-9425
Practice Address - Street 1:45 MAIN ST
Practice Address - Street 2:SUITE 408
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1000
Practice Address - Country:US
Practice Address - Phone:866-662-4560
Practice Address - Fax:877-279-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8717401Medicaid
NJ051704Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER