1346298114 NPI number — PEDIATRIC HEMATOLOGY ONCOLOGY ASSOCIATES ST BARNABAS MEDICAL CTR

Table of content: (NPI 1346298114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346298114 NPI number — PEDIATRIC HEMATOLOGY ONCOLOGY ASSOCIATES ST BARNABAS MEDICAL CTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC HEMATOLOGY ONCOLOGY ASSOCIATES ST BARNABAS MEDICAL CTR
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:
SBMC PEDIATRIC HEMATOLOGY AND ONCOLOGY
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:
1346298114
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18226
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07191-8226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-557-7160
Provider Business Mailing Address Fax Number:
732-557-7109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94 OLD SHORT HILLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07039-5672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-322-2800
Provider Business Practice Location Address Fax Number:
973-322-2856
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESPOSITO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
732-557-7160

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7243308 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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