Basic Information
| Provider Information | |||||||||
| NPI: | 1770569832 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RARITAN BAY MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 NEW BRUNSWICK AVE | ||||||||
| Address2: | |||||||||
| City: | PERTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088613674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324423700 | ||||||||
| FaxNumber: | 7323244811 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 NEW BRUNSWICK AVE | ||||||||
| Address2: | |||||||||
| City: | PERTH AMBOY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088613674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324423700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2005 | ||||||||
| LastUpdateDate: | 01/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | D'AGNES | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO | ||||||||
| AuthorizedOfficialTelephone: | 7324423700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 11203 | NJ | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 4137809 | 05 | NJ | MEDICAID |