| 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 | Brittain Brantley (ACTING PRESIDENT) |
| Authorized Official Contact | 3023005138 |
| 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 | 08/13/2026 |
| Certification Date | 08/13/2026 |
| 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 | (NU) | Primary |
| Provider Name | Ritu Suri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972696409 PECOS PAC ID: 9133013600 Enrollment ID: I20040214000154 |
| Provider Name | Alla Katseva |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1871547950 PECOS PAC ID: 2769450535 Enrollment ID: I20040920000685 |
| Provider Name | Hossam M Khalil |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295733970 PECOS PAC ID: 6800847146 Enrollment ID: I20050210000563 |
| Provider Name | Kavitha Thukkaram |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003854282 PECOS PAC ID: 1355521238 Enrollment ID: I20110209000951 |
| Provider Name | Gary B Bernett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548204985 PECOS PAC ID: 4486559341 Enrollment ID: I20140116000158 |
| Provider Name | Suman M Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720498678 PECOS PAC ID: 9830412832 Enrollment ID: I20141224000337 |
| Provider Name | Ann Dalton Bagchi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063935641 PECOS PAC ID: 4385906833 Enrollment ID: I20180320003170 |
| Provider Name | Annie Varghese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649708116 PECOS PAC ID: 1355696600 Enrollment ID: I20180611000750 |
| Provider Name | Rosemarie Encinas Gozum |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053870881 PECOS PAC ID: 4486987971 Enrollment ID: I20191126000715 |
| Provider Name | Jason Shi-jiang Woo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962744573 PECOS PAC ID: 4082855440 Enrollment ID: I20200618002551 |
| Provider Name | Raafat a Gorgy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700137734 PECOS PAC ID: 9638494743 Enrollment ID: I20250224001554 |
| Provider Name | Tamila Kadyr-akhunova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184595431 PECOS PAC ID: 5597243493 Enrollment ID: I20260202001479 |
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