1013047794 NPI number — THE COLLEGE OF NEW JERSEY STUDENT HEALTH SERVICES

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 1013047794 NPI number — THE COLLEGE OF NEW JERSEY STUDENT HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE COLLEGE OF NEW JERSEY STUDENT HEALTH SERVICES
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:
1013047794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 PENNINGTON ROAD
Provider Second Line Business Mailing Address:
EICKHOFF HALL 107
Provider Business Mailing Address City Name:
EWING
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08618-1104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-771-2889
Provider Business Mailing Address Fax Number:
609-637-5131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 PENNINGTON RD
Provider Second Line Business Practice Location Address:
EICKHOFF HALL 107
Provider Business Practice Location Address City Name:
EWING
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08618-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-771-2889
Provider Business Practice Location Address Fax Number:
609-637-5131
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HELLER
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
BAKER
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
609-771-2889

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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