Provider Demographics
NPI:1720234982
Name:VISITING DOCTORS OF NEW JERSEY, LLC
Entity type:Organization
Organization Name:VISITING DOCTORS OF NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-692-0650
Mailing Address - Street 1:1421 SUMMIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753
Mailing Address - Country:US
Mailing Address - Phone:732-692-0650
Mailing Address - Fax:732-358-0349
Practice Address - Street 1:1421 SUMMIT AVENUE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-692-0650
Practice Address - Fax:732-358-0349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB66440207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1841248598Medicare NSC
NJ1760477061Medicare NSC
NJ1649305442Medicare NSC