Provider Demographics
NPI:1780951525
Name:ALTUS MEDICAL CARE LLC
Entity type:Organization
Organization Name:ALTUS MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJNISH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-851-1970
Mailing Address - Street 1:1545 HARBOURTON ROCKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08530-3003
Mailing Address - Country:US
Mailing Address - Phone:609-851-1970
Mailing Address - Fax:
Practice Address - Street 1:3840 QUAKERBRIDGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1003
Practice Address - Country:US
Practice Address - Phone:609-890-4200
Practice Address - Fax:609-586-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07620800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ231981Medicare PIN