Basic Information
| Provider Information | |||||||||
| NPI: | 1114554532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RWJBH ASSOCIATES 2, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RWJBARNABAS RENAISSANCE PRIMARY CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 EXECUTIVE DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088734007 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 155 JEFFERSON ST # LL | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071056906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733445498 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2020 | ||||||||
| LastUpdateDate: | 03/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | AMARAIN | ||||||||
| AuthorizedOfficialFirstName: | AMATO | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9733224594 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.