1104951482 NPI number — UMDNJ RWJ GENERAL THORACIC SURGERY

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 1104951482 NPI number — UMDNJ RWJ GENERAL THORACIC SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UMDNJ RWJ GENERAL THORACIC SURGERY
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:
1104951482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 W GILBERT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BANK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-212-0051
Provider Business Mailing Address Fax Number:
732-212-0713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 PATERSON ST
Provider Second Line Business Practice Location Address:
GENERAL THORACIC SURGERY SUITE 4100
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901-1962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-235-7800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLUGEWICZ
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
732-212-0051

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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