NPIMap

Organization Active NPI

Ridgedale Family Medical Associates PC

  • Non-Pharmacy Dispensing Site
  • East Hanover, NJ
National Provider Identifier
1639595481
Registry record updated Mar 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
25MA05975800 Issued in NJ
Legal business name
RIDGEDALE FAMILY MEDICAL ASSOCIATES PC
Practice address
383 Ridgedale Ave
Suite 8
East Hanover, NJ 07936-1445
Phone
(973) 887-0200
NPI assigned
Mar 17, 2014
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2014

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

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 964-1506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 25MA05975800 NJ Primary

Addresses

Primary practice location

383 Ridgedale Ave
Suite 8
East Hanover, NJ 07936-1445

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • Ridgedale Family Medical Doing business as

National Provider Directory

National Provider Directory
Part of
Tri - State Medical Group Inc

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395014400000",
    "number": "1639595481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "383 RIDGEDALE AVE",
            "address_2": "SUITE 8",
            "city": "EAST HANOVER",
            "state": "NJ",
            "postal_code": "079361445",
            "telephone_number": "973-887-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGEDALE FAMILY MEDICAL ASSOCIATES PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2014-03-17",
        "last_updated": "2014-03-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NJ",
            "license": "25MA05975800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ridgedale Family Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Hanover, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.