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  7. NPI Record 1265529523

RARITAN BAY MEDICAL CENTER PROFESSIONAL SERVICES
Complete NPI Record 1265529523
Specialist in Perth Amboy, NJ

NPI Status: Active since October 06, 2006

Contact Information

530 NEW BRUNSWICK AVE
PERTH AMBOY, NJ
ZIP 08861
Phone: (732) 324-6065
Fax: (732) 324-6063

Get Directions

Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Business Practice Location Address Fax Number
  18. Provider Enumeration Date
  19. Last Update Date
  20. Authorized Official Last Name
  21. Authorized Official First Name
  22. Authorized Official Title or Position
  23. Authorized Official Telephone Number
  24. Healthcare Provider Taxonomy Code 1
  25. Provider License Number 1
  26. Provider License Number State Code 1
  27. Healthcare Provider Primary Taxonomy Switch 1
  28. Healthcare Provider Taxonomy Code 2
  29. Provider License Number 2
  30. Provider License Number State Code 2
  31. Healthcare Provider Primary Taxonomy Switch 2
  32. Healthcare Provider Taxonomy Code 3
  33. Provider License Number 3
  34. Provider License Number State Code 3
  35. Healthcare Provider Primary Taxonomy Switch 3
  36. Healthcare Provider Taxonomy Code 4
  37. Provider License Number 4
  38. Provider License Number State Code 4
  39. Healthcare Provider Primary Taxonomy Switch 4
  40. Healthcare Provider Taxonomy Code 5
  41. Provider License Number 5
  42. Provider License Number State Code 5
  43. Healthcare Provider Primary Taxonomy Switch 5
  44. Healthcare Provider Taxonomy Code 6
  45. Provider License Number 6
  46. Provider License Number State Code 6
  47. Healthcare Provider Primary Taxonomy Switch 6
  48. Healthcare Provider Taxonomy Code 7
  49. Provider License Number 7
  50. Provider License Number State Code 7
  51. Healthcare Provider Primary Taxonomy Switch 7
  52. Healthcare Provider Taxonomy Code 8
  53. Provider License Number 8
  54. Provider License Number State Code 8
  55. Healthcare Provider Primary Taxonomy Switch 8
  56. Healthcare Provider Taxonomy Code 9
  57. Provider License Number 9
  58. Provider License Number State Code 9
  59. Healthcare Provider Primary Taxonomy Switch 9
  60. Healthcare Provider Taxonomy Code 10
  61. Provider License Number 10
  62. Provider License Number State Code 10
  63. Healthcare Provider Primary Taxonomy Switch 10
  64. Healthcare Provider Taxonomy Code 11
  65. Provider License Number 11
  66. Provider License Number State Code 11
  67. Healthcare Provider Primary Taxonomy Switch 11
  68. Healthcare Provider Taxonomy Code 12
  69. Provider License Number 12
  70. Provider License Number State Code 12
  71. Healthcare Provider Primary Taxonomy Switch 12
  72. Healthcare Provider Taxonomy Code 13
  73. Provider License Number 13
  74. Provider License Number State Code 13
  75. Healthcare Provider Primary Taxonomy Switch 13
  76. Healthcare Provider Taxonomy Code 14
  77. Provider License Number 14
  78. Provider License Number State Code 14
  79. Healthcare Provider Primary Taxonomy Switch 14
  80. Healthcare Provider Taxonomy Code 15
  81. Provider License Number 15
  82. Provider License Number State Code 15
  83. Healthcare Provider Primary Taxonomy Switch 15
  84. Is Organization Subpart
  85. Healthcare Provider Taxonomy Group 1
  86. Healthcare Provider Taxonomy Group 2
  87. Healthcare Provider Taxonomy Group 3
  88. Healthcare Provider Taxonomy Group 4
  89. Healthcare Provider Taxonomy Group 5
  90. Healthcare Provider Taxonomy Group 6
  91. Healthcare Provider Taxonomy Group 7
  92. Healthcare Provider Taxonomy Group 8
  93. Healthcare Provider Taxonomy Group 9
  94. Healthcare Provider Taxonomy Group 10
  95. Healthcare Provider Taxonomy Group 11
  96. Healthcare Provider Taxonomy Group 12
  97. Healthcare Provider Taxonomy Group 13
  98. Healthcare Provider Taxonomy Group 14
  99. Healthcare Provider Taxonomy Group 15

Complete NPI Dataset

This page represents the complete record for NPI 1265529523. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1265529523
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: PO BOX 48270
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: NEWARK
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NJ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 071014800
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 2018189118
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 530 NEW BRUNSWICK AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: PERTH AMBOY
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NJ
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 088613654
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7323246065
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 7323246063
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 10/6/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/22/2020
The date that a record was last updated or changed.
Authorized Official Last Name: SHANAHAN
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: TOM
The first name of the authorized official.
Authorized Official Title or Position: CEO
The title or position of the authorized official.
Authorized Official Telephone Number: 7322932314
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 174400000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 25MA04033300
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: NJ
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 174400000X
Provider License Number 2: 25MA07854400
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: NJ
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 174400000X
Provider License Number 3: 25MA07056200
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: NJ
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 174400000X
Provider License Number 4: 25MA07043800
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: NJ
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 174400000X
Provider License Number 5: 25MA07115800
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 5: NJ
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 174400000X
Provider License Number 6: 25MA05898100
Provider License Number State Code 6: NJ
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 174400000X
Provider License Number 7: 25MA02777800
Provider License Number State Code 7: NJ
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 174400000X
Provider License Number 8: 25MA05255000
Provider License Number State Code 8: NJ
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 174400000X
Provider License Number 9: 25MA05746900
Provider License Number State Code 9: NJ
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 174400000X
Provider License Number 10: 25MA05696500
Provider License Number State Code 10: NJ
Healthcare Provider Primary Taxonomy Switch 10: N
Healthcare Provider Taxonomy Code 11: 174400000X
Provider License Number 11: 25MA05873200
Provider License Number State Code 11: NJ
Healthcare Provider Primary Taxonomy Switch 11: N
Healthcare Provider Taxonomy Code 12: 174400000X
Provider License Number 12: 25MA03053200
Provider License Number State Code 12: NJ
Healthcare Provider Primary Taxonomy Switch 12: N
Healthcare Provider Taxonomy Code 13: 174400000X
Provider License Number 13: 25MA02710200
Provider License Number State Code 13: NJ
Healthcare Provider Primary Taxonomy Switch 13: N
Healthcare Provider Taxonomy Code 14: 174400000X
Provider License Number 14: 25MA03479600
Provider License Number State Code 14: NJ
Healthcare Provider Primary Taxonomy Switch 14: N
Healthcare Provider Taxonomy Code 15: 174400000X
Provider License Number 15: 25MA07766200
Provider License Number State Code 15: NJ
Healthcare Provider Primary Taxonomy Switch 15: Y
Is Organization Subpart: N
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 8: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 9: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 10: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 11: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 12: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 13: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 14: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 15: 193200000X MULTI-SPECIALTY GROUP