Provider Demographics
NPI:1588745640
Name:JSR HEALTHCARE, PC
Entity type:Organization
Organization Name:JSR HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-467-2009
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08014-0067
Mailing Address - Country:US
Mailing Address - Phone:856-467-2009
Mailing Address - Fax:856-467-2535
Practice Address - Street 1:510 HERON DR
Practice Address - Street 2:SUITE107
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1767
Practice Address - Country:US
Practice Address - Phone:856-467-2009
Practice Address - Fax:856-467-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA304848261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC29075Medicare UPIN
NJ504186Medicare PIN
NJC29075Medicare PIN