Provider Demographics
NPI:1366528341
Name:BRUNSWICK URGENT CARE P A
Entity type:Organization
Organization Name:BRUNSWICK URGENT CARE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-422-4889
Mailing Address - Street 1:PO BOX 5034
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-5034
Mailing Address - Country:US
Mailing Address - Phone:732-422-4889
Mailing Address - Fax:732-940-8724
Practice Address - Street 1:3185 RT. 27
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823-1313
Practice Address - Country:US
Practice Address - Phone:732-422-4889
Practice Address - Fax:732-940-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06437800207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7342403Medicaid
NJG57341Medicare UPIN
NJ088005Medicare PIN