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OPTUM MEDICAL CARE OF NEW JERSEY PC NPI 1578665048


NPI Information

NPI: 1578665048
Provider Name: OPTUM MEDICAL CARE OF NEW JERSEY PC

Former Legal Business Name: RIVERSIDE PEDIATRIC GROUP

Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
1 HARMON PLZ FL 10
SECAUCUS, NJ
ZIP 07094
Phone: (201) 636-7233
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OPTUM MEDICAL CARE OF NEW JERSEY PC is a pediatrics in Secaucus, NJ. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. OPTUM MEDICAL CARE OF NEW JERSEY PC NPI is 1578665048. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Riverside Pediatric Group.

The provider's business location address is:

1 HARMON PLZ FL 10
SECAUCUS, NJ
ZIP 07094-803
Phone: (201) 636-7233
Fax: (201) 552-2358

The provider's authorized official is Gaurang Brahmbhatt .
The authorized official title is Cmo and has the following contact phone number (201) 636-7233.

The enumeration date for this NPI number is 9/3/2006 and was last updated on 9/14/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical SuppliesNEW JERSEYNo
2207R00000XInternal Medicine25MA08407900NEW JERSEYNo
3208000000XPediatrics25MA03363500NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
19088008MEDICAIDNEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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