Provider Demographics
NPI:1215947106
Name:DIGITRACE CARE SERVICES INC
Entity type:Organization
Organization Name:DIGITRACE CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:IBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-536-7400
Mailing Address - Street 1:200 CORPORATE PL
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3840
Mailing Address - Country:US
Mailing Address - Phone:978-536-7400
Mailing Address - Fax:978-535-9757
Practice Address - Street 1:401 S VAN BRUNT ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4604
Practice Address - Country:US
Practice Address - Phone:610-543-6800
Practice Address - Fax:610-543-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0658107000OtherAMERIHEALTH HMO
NJ0453320000OtherAMERIHEALTH PERS CHOICE
NJ0658107000OtherKEYSTONE
NJ7618325OtherAETNA