Provider Demographics
NPI:1649280629
Name:DEER CHASE MEDICAL ASSOCIATES PA
Entity type:Organization
Organization Name:DEER CHASE MEDICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:GUARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-286-0440
Mailing Address - Street 1:160 STATE HIGHWAY 37 WEST
Mailing Address - Street 2:SUITE A DEER CHASE PROFESSIONAL PARK
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8056
Mailing Address - Country:US
Mailing Address - Phone:732-286-0440
Mailing Address - Fax:732-286-2885
Practice Address - Street 1:160 STATE HIGHWAY 37 WEST
Practice Address - Street 2:SUITE A DEER CHASE PROFESSIONAL PARK
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8056
Practice Address - Country:US
Practice Address - Phone:732-286-0440
Practice Address - Fax:732-286-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6610005Medicaid
NJ6610005Medicaid