1649311366 NPI number — SOMERSET MEDICAL CENTER

Table of content: (NPI 1649311366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649311366 NPI number — SOMERSET MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOMERSET 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:
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:
1649311366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 REHILL AVE
Provider Second Line Business Mailing Address:
ADMINISTRATIVE OFFICE, ATTENTION CFO
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08876-2598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-595-2682
Provider Business Mailing Address Fax Number:
908-685-2894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 REHILL AVE
Provider Second Line Business Practice Location Address:
ATTENTION: SOMERSET FAMILY PRACTICE
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08876-2598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-685-2900
Provider Business Practice Location Address Fax Number:
908-685-2891
Provider Enumeration Date:
02/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
O'BRIEN
Authorized Official First Name:
CARL
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT-FINANCE, CFO
Authorized Official Telephone Number:
908-595-2682

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080S0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8488002 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".