1205047651 NPI number — UMDNJ UNIVERSITY HOSPITAL

Table of content: (NPI 1205047651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205047651 NPI number — UMDNJ UNIVERSITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UMDNJ UNIVERSITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205047651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DOCTOR'S OFFICE CENTER, SUITE 1200
Provider Second Line Business Mailing Address:
90 BERGEN ST.
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-972-2153
Provider Business Mailing Address Fax Number:
973-972-5296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 BERGEN ST
Provider Second Line Business Practice Location Address:
ACC SUITE D1610
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-2153
Provider Business Practice Location Address Fax Number:
973-972-5296
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MERRITT
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
GALAINI
Authorized Official Title or Position:
PHYSICIAN ASSISTANT
Authorized Official Telephone Number:
973-972-2153

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  25MP00003300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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