NPIMap

Organization Active NPI

Pai Participant 25 PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Phillipsburg, NJ
National Provider Identifier
1568028314
Registry record updated Aug 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
PAI PARTICIPANT 25 PC
Practice address
290 Red School LN
Phillipsburg, NJ 08865-2276
Phone
(908) 859-2800
Fax
(908) 859-4532
NPI assigned
May 17, 2019
Last updated
Aug 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brittain Brantley
Title
Acting President
Phone
(302) 300-5138

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU Primary

Addresses

Primary practice location

290 Red School LN
Phillipsburg, NJ 08865-2276

Mailing address

PO Box 639676
Cincinnati, OH 45263-9676
Phone (859) 291-4800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190910002368 NJ Part B Supplier - Clinic/Group Practice 3072842442 Receives reassigned benefits from 12 practitioners
Practice locations: Cedar Grove, NJ; Cliffwood, NJ; Cresskill, NJ; East Brunswick, NJ; Edison, NJ; Emerson, NJ; Wyckoff, NJ; Woodcliff Lake, NJ…

National Provider Directory

National Provider Directory

Locations

310 Buckelew Ave
Monroe Township, NJ 08831
Phone (609) 521-8855

111 Bowne Rd
Ocean, NJ 07712
Phone (732) 523-5797

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786579200000",
    "number": "1568028314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639676",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639676",
            "telephone_number": "859-291-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 RED SCHOOL LN",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088652276",
            "telephone_number": "908-859-2800",
            "fax_number": "908-859-4532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAI PARTICIPANT 25 PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-17",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A",
        "authorized_official_last_name": "BRANTLEY",
        "authorized_official_first_name": "BRITTAIN",
        "authorized_official_title_or_position": "ACTING PRESIDENT",
        "authorized_official_telephone_number": "302-300-5138"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phillipsburg, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.