Provider Demographics
NPI:1952350522
Name:ATLANTIC COAST RHEUMATOLOGY, P.C.
Entity Type:Organization
Organization Name:ATLANTIC COAST RHEUMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-505-3510
Mailing Address - Street 1:PO BOX 1244
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-1244
Mailing Address - Country:US
Mailing Address - Phone:732-349-2795
Mailing Address - Fax:732-349-2795
Practice Address - Street 1:442D COMMONS WAY
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6429
Practice Address - Country:US
Practice Address - Phone:732-505-3510
Practice Address - Fax:732-505-5308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA58633800174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0060461Medicaid
NJ0060461Medicaid