Provider Demographics
NPI:1124159363
Name:TRICOUNTY CARE MANAGEMENT ORGANIZATION
Entity type:Organization
Organization Name:TRICOUNTY CARE MANAGEMENT ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-526-3900
Mailing Address - Street 1:1250 STATE ROUTE 28 STE 101
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3389
Mailing Address - Country:US
Mailing Address - Phone:908-526-3900
Mailing Address - Fax:908-526-5278
Practice Address - Street 1:1250 STATE ROUTE 28 STE 101
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3389
Practice Address - Country:US
Practice Address - Phone:908-526-3900
Practice Address - Fax:908-526-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8458600Medicaid