Provider Demographics
NPI:1306954243
Name:RARITAN BAY MEDICAL CENTER
Entity type:Organization
Organization Name:RARITAN BAY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILPERIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-293-2314
Mailing Address - Street 1:PO BOX 11665
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4665
Mailing Address - Country:US
Mailing Address - Phone:732-293-2314
Mailing Address - Fax:732-952-8841
Practice Address - Street 1:530 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3654
Practice Address - Country:US
Practice Address - Phone:732-293-2314
Practice Address - Fax:732-952-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0001431OtherNEO GHI PPO GROUP #
NJDD0800OtherSURGERY RRMDCR GROUP #
NJ0001431OtherSURGERY GHI PPO GROUP #
NJ0013003OtherFP AETNA HMO GROUP #
NJ2697433000OtherOBGYN AMERIHEALTH GROUP #
NJ4137809OtherBRUG HEALTHSTART MEDICAID
NJ6420530OtherFP AETNA PPO GROUP #
NJ0013003OtherNEO AETNA HMO GROUP #
NJ0004310000OtherNEO AMERIHEALTH GROUP #
NJDD0800OtherPATH RRMDCR GROUP #
NJ7314162OtherNEO AETNA PPO GROUP #
NJ0004310000OtherPATH AMERIHEALTH GROUP #
NJDD0800OtherSURGERY RRMDCR GROUP #
NJ084884Medicare PIN
NJ7314162OtherNEO AETNA PPO GROUP #