Provider Demographics
NPI:1316152812
Name:NEW JERSEY PROCARE LLC
Entity type:Organization
Organization Name:NEW JERSEY PROCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KINNARI
Authorized Official - Middle Name:ASHOK
Authorized Official - Last Name:KOTHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-772-0700
Mailing Address - Street 1:1 BRITTON PL
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2514
Mailing Address - Country:US
Mailing Address - Phone:856-772-0700
Mailing Address - Fax:856-864-0310
Practice Address - Street 1:1 BRITTON PL
Practice Address - Street 2:SUITE 6
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2514
Practice Address - Country:US
Practice Address - Phone:856-772-0700
Practice Address - Fax:856-864-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA054424002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0445029000OtherAMERIHEALTH
NJ1491806Medicaid
NJP3645687OtherOXFORD
NJ7534730OtherAETNA
NJ0445029000OtherBLUE CROSS
NJ050886OtherVALUE OPTION
NJ202304OtherMENTAL HEALTH NETWORK
NJP3645687OtherOXFORD
NJ7534730OtherAETNA
NJ1491806Medicaid