1861629156 NPI number — CLARA MAASS MEDICAL CENTER

Table of content: (NPI 1861629156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861629156 NPI number — CLARA MAASS MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLARA MAASS MEDICAL CENTER
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:
CLARA MAASS MEDICAL CENTER TRANSITIONAL CARE UNIT
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:
1861629156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CLARA MAASS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07109-3550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-450-2000
Provider Business Mailing Address Fax Number:
973-844-4908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CLARA MAASS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07109-3550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-450-2008
Provider Business Practice Location Address Fax Number:
973-844-4908
Provider Enumeration Date:
06/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
CLYNE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
973-450-2002

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  10701 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , 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: 4135504 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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