| Pai Participant 25 Pc | |
|
290 Red School Ln Phillipsburg NJ 08865-2276 | |
| (908) 859-2800 | |
| (908) 859-4532 |
| Full Name | Pai Participant 25 Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 290 Red School Ln, Phillipsburg, New Jersey |
| Authorized Official Name and Position | Erin N Laird (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4104588713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pai Participant 25 Pc Po Box 639676 Cincinnati OH 45263-9676 Ph: (859) 291-4800 | Pai Participant 25 Pc 290 Red School Ln Phillipsburg NJ 08865-2276 Ph: (908) 859-2800 |
| NPI Number | 1568028314 |
|---|---|
| Provider Enumeration Date | 05/17/2019 |
| Last Update Date | 08/10/2020 |
| Medicare PECOS PAC ID | 3072842442 |
|---|---|
| Medicare Enrollment ID | O20190910002368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568028314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Gary B Bernett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548204985 PECOS PAC ID: 4486559341 Enrollment ID: I20140116000158 |
| Provider Name | Jason Woo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962744573 PECOS PAC ID: 4082855440 Enrollment ID: I20200618002551 |
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