Provider Demographics
NPI:1770749145
Name:ERICKSON HEALTH MEDICAL GROUP OF NEW JERSEY PC
Entity type:Organization
Organization Name:ERICKSON HEALTH MEDICAL GROUP OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP/CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:NARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-402-2261
Mailing Address - Street 1:5525 RESEARCH PARK DR FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:973-831-3540
Mailing Address - Fax:973-831-3503
Practice Address - Street 1:1 CEDAR CREST VILLAGE DR
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444-2100
Practice Address - Country:US
Practice Address - Phone:973-831-3540
Practice Address - Fax:973-831-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6145940003Medicare NSC