Provider Demographics
NPI:1548331903
Name:GERICARE ASSOC LLC
Entity type:Organization
Organization Name:GERICARE ASSOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-227-6588
Mailing Address - Street 1:1405 CHEWS LANDING RD
Mailing Address - Street 2:STE 4
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2769
Mailing Address - Country:US
Mailing Address - Phone:856-228-1118
Mailing Address - Fax:856-228-9928
Practice Address - Street 1:1405 CHEWS LANDING RD
Practice Address - Street 2:STE 4
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2769
Practice Address - Country:US
Practice Address - Phone:856-228-1118
Practice Address - Fax:856-228-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05722900207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ107601Medicare PIN