Provider Demographics
NPI:1538361878
Name:HAZLET HEALTH CARE
Entity type:Organization
Organization Name:HAZLET HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RICCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-264-5656
Mailing Address - Street 1:3253 STATE ROUTE 35
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1544
Mailing Address - Country:US
Mailing Address - Phone:732-264-5656
Mailing Address - Fax:732-264-8625
Practice Address - Street 1:3253 STATE ROUTE 35
Practice Address - Street 2:SUITE 1
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1544
Practice Address - Country:US
Practice Address - Phone:732-264-5656
Practice Address - Fax:732-264-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05277600261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJHA419282Medicare ID - Type UnspecifiedLEGACY NUMBER