Provider Demographics
NPI:1366590945
Name:PLEASANT RUN FAMILY PHYSICIANS
Entity type:Organization
Organization Name:PLEASANT RUN FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DETOMMASO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:908-788-9468
Mailing Address - Street 1:925 US HIGHWAY 202
Mailing Address - Street 2:
Mailing Address - City:NESHANIC STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08853-3503
Mailing Address - Country:US
Mailing Address - Phone:908-788-9468
Mailing Address - Fax:908-788-5720
Practice Address - Street 1:925 US HIGHWAY 202
Practice Address - Street 2:
Practice Address - City:NESHANIC STATION
Practice Address - State:NJ
Practice Address - Zip Code:08853-3503
Practice Address - Country:US
Practice Address - Phone:908-788-9468
Practice Address - Fax:908-788-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3264505Medicaid
NJ528151Medicare ID - Type Unspecified