MEDICARE: BATARSEH WALK IN MEDICAL CENTER, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1790005312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BATARSEH WALK IN MEDICAL CENTER, LLC.

Provider Business Mailing Address
First Line	:	540 BORDENTOWN AVE
Second Line	:	SUITE 2100
City	:	SOUTH AMBOY
State	:	NJ
Zip	:	08879-1546
Country	:	US
Telephone Number	:	731-721-1500
Fax Number	:	732-721-1599

Provider Business Practice Location Address
First Line	:	540 BORDENTOWN AVE
Second Line	:	SUITE 2100
City	:	SOUTH AMBOY
State	:	NJ
Zip	:	08879-1546
Country	:	US
Telephone Number	:	731-721-1500
Fax Number	:	732-721-1599

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. HANI BATARSEH
Credential	:	M.D.
Telephone Number	:	732-721-1500

Provider Enumeration Date	:	06/05/2010
Last Update Date	:	06/05/2010

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