Provider Demographics
NPI:1952097156
Name:EAST RIVER MEDICAL ASSOCIATES OF NEW JERSEY PC
Entity type:Organization
Organization Name:EAST RIVER MEDICAL ASSOCIATES OF NEW JERSEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:WETMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-606-1206
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:GREAT RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11739-0626
Mailing Address - Country:US
Mailing Address - Phone:631-892-2745
Mailing Address - Fax:631-201-3179
Practice Address - Street 1:400 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07430-3516
Practice Address - Country:US
Practice Address - Phone:212-606-1206
Practice Address - Fax:631-201-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty