Provider Demographics
NPI:1538387162
Name:FOREST HEALTHCARE ASSOCIATES, PC
Entity type:Organization
Organization Name:FOREST HEALTHCARE ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MENACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-986-1787
Mailing Address - Street 1:277 FOREST AVE
Mailing Address - Street 2:200
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5428
Mailing Address - Country:US
Mailing Address - Phone:201-986-1881
Mailing Address - Fax:201-986-1871
Practice Address - Street 1:277 FOREST AVE
Practice Address - Street 2:#200
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-986-1881
Practice Address - Fax:201-986-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31D1027413291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00408234Medicare PIN
NJ108957Medicare PIN