1790059947 NPI number — HUMC OPCO, LLC

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 1790059947 NPI number — HUMC OPCO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMC OPCO, LLC
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:
HOBOKEN UNIVERSITY MEDICAL CENTER
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:
1790059947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 WILLOW AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOBOKEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07030-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-418-1000
Provider Business Mailing Address Fax Number:
201-418-2040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 WILLOW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOBOKEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07030-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-418-2184
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER OF MANAGECARE CREDENTIALING
Authorized Official Telephone Number:
201-821-8911

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  10908 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 282N00000X . This is a "HOSPITAL - LONG TERM CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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