1669462420 NPI number — ST JOSEPHS UNIVERSITY MEDICAL CENTER INC.

Table of content: (NPI 1669462420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669462420 NPI number — ST JOSEPHS UNIVERSITY MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOSEPHS UNIVERSITY MEDICAL CENTER INC.
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:
ST JOSEPHS HOSPITAL AND MEDICAL CENTER
Provider Other Organization Name Type Code:
4
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:
1669462420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PATERSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07503-2621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-754-2000
Provider Business Mailing Address Fax Number:
973-754-2149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07503-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-754-2000
Provider Business Practice Location Address Fax Number:
973-754-2149
Provider Enumeration Date:
10/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CAULFIELD
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR, FINANCE
Authorized Official Telephone Number:
973-754-2016

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  11605 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 11605 , 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)

  • Identifier: 4136403 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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