Basic Information
| Provider Information | |||||||||
| NPI: | 1538387162 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOREST HEALTHCARE ASSOCIATES, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FOREST HLTHCR PATHOLOGY LAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 277 FOREST AVE | ||||||||
| Address2: | 200 | ||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076525428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019861881 | ||||||||
| FaxNumber: | 2019861871 | ||||||||
| Practice Location | |||||||||
| Address1: | 277 FOREST AVE | ||||||||
| Address2: | #200 | ||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019861881 | ||||||||
| FaxNumber: | 2019861871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 05/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | MENACKER | ||||||||
| AuthorizedOfficialFirstName: | MOREY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2019861787 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 31D1027413 | NJ | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.