Provider Demographics
NPI:1508606237
Name:OPTUM MEDICAL CARE OF NEW JERSEY PC
Entity type:Organization
Organization Name:OPTUM MEDICAL CARE OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GAURANG
Authorized Official - Middle Name:RAVAJI
Authorized Official - Last Name:BRAHMBHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-706-8490
Mailing Address - Street 1:1 HARMON PLZ FL 10
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2803
Mailing Address - Country:US
Mailing Address - Phone:551-220-4832
Mailing Address - Fax:551-257-7255
Practice Address - Street 1:264 BOYDEN AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3070
Practice Address - Country:US
Practice Address - Phone:973-761-5200
Practice Address - Fax:973-761-7617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTUM MEDICAL CARE OF NEW JERSEY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies