Provider Demographics
NPI:1154351666
Name:PASSALARIS, JOHN D (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:PASSALARIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:DIMITRIOS
Other - Last Name:PASSALARIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:800 BUNN DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1968
Mailing Address - Country:US
Mailing Address - Phone:609-921-2800
Mailing Address - Fax:609-921-3499
Practice Address - Street 1:800 BUNN DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1968
Practice Address - Country:US
Practice Address - Phone:609-921-2800
Practice Address - Fax:609-921-3499
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07224100207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2080707000OtherKEYSTONE HEALTH PLAN
223258770OtherBEECHSTREET
2080707000OtherAMERIHEALTH HMO
223258770OtherUNITED HEALTH CARE
1391578OtherAMERIHEALTH ADMIN PPO
223258770OtherAARP HEALTH INSURANCE
223258770OtherGREAT WEST
223258770OtherMAGNA CARE
2K2546OtherHEALTHNET
NJ8561605Medicaid
P2523822OtherOXFORD HEALTH PLANS
223258770OtherGHI
060063735OtherRAILROAD MEDICARE
232258770OtherCIGNA
2607048OtherAETNA US HEALTHCARE
PA1391578OtherBLUE SHIELD PA
NJ223258770OtherHORZON BCBS OF NJ
223258770OtherDEVON
223258770OtherGREAT WEST
223258770OtherUNITED HEALTH CARE