1710117437 NPI number — RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710117437 NPI number — RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
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:
RUTGERS UNIVERSITY SPORTS MEDICINE
Provider Other Organization Name Type Code:
3
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:
1710117437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 168007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75016-8007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-890-6390
Provider Business Mailing Address Fax Number:
325-437-8390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SCARLET KNIGHT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PISCATAWAY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08854-8069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-445-6258
Provider Business Practice Location Address Fax Number:
732-445-2780
Provider Enumeration Date:
07/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JEITNER
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ATHLETIC INSURANCE COORDINATOR
Authorized Official Telephone Number:
732-445-6258

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com