1477304541 NPI number — ST JOSEPHS UNIVERSITY MEDICAL CENTER INC.

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 1477304541 NPI number — ST JOSEPHS UNIVERSITY MEDICAL CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOSEPHS UNIVERSITY MEDICAL CENTER INC.
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:
1477304541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
703 MAIN STREET
Provider Second Line Business Mailing Address:
REGAN BUILDING BASEMENT, RM RB37
Provider Business Mailing Address City Name:
PATERSON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07503-2621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-754-5640
Provider Business Mailing Address Fax Number:
973-754-3095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 MAIN STREET
Provider Second Line Business Practice Location Address:
REGAN BUILDING BASEMENT, RM RB37
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07503-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-754-5640
Provider Business Practice Location Address Fax Number:
973-754-3095
Provider Enumeration Date:
03/28/2024

Additional Information

Authorized Official

Authorized Official Last Name:
RICCIO
Authorized Official First Name:
DUSTIN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
585-368-6419

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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