Organization
RARITAN BAY MEDICAL CENTER PROFESSIONAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM SHANAHAN (CEO)
(732) 293-2314
Entity
Organization
Contact information
Practice address
2433 COUNTY HIGHWAY 516, SUITE 3B, OLD BRIDGE, NJ 08857
(732) 360-0287
(732) 360-1279
Mailing address
PO BOX 48270, NEWARK, NJ 07101-4800
(201) 818-9118
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
25MA03645000
NJ
174400000X
Specialist
Primary
25MA03951900
NJ
174400000X
Specialist
25MA07854400
NJ
Other
Enumeration date
10/12/2006
Last updated
08/22/2020
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