Provider Demographics
NPI:1720287550
Name:PHYSICIANS HOME & HEALTH SERVICES
Entity Type:Organization
Organization Name:PHYSICIANS HOME & HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-775-8400
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07754-0518
Mailing Address - Country:US
Mailing Address - Phone:732-775-8400
Mailing Address - Fax:732-775-8401
Practice Address - Street 1:1532 CORLIES AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4904
Practice Address - Country:US
Practice Address - Phone:732-775-8400
Practice Address - Fax:732-775-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06388400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG56560Medicare UPIN