Provider Demographics
NPI:1023092236
Name:AMERIGROUP NEW JERSEY, INC.
Entity type:Organization
Organization Name:AMERIGROUP NEW JERSEY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAYTAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-452-6000
Mailing Address - Street 1:399 THORNALL ST
Mailing Address - Street 2:NINTH FLOOR
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2236
Mailing Address - Country:US
Mailing Address - Phone:732-452-6000
Mailing Address - Fax:732-452-0407
Practice Address - Street 1:399 THORNALL ST
Practice Address - Street 2:NINTH FLOOR
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2236
Practice Address - Country:US
Practice Address - Phone:732-452-6000
Practice Address - Fax:732-452-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ670043Medicaid