1952449399 NPI number — RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY

Table of content: (NPI 1952449399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952449399 NPI number — RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
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:
6
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:
1952449399
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1077
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PISCATAWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08855-1077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
848-932-4982
Provider Business Mailing Address Fax Number:
732-932-4992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 COMMERCIAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901-2786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
848-932-4982
Provider Business Practice Location Address Fax Number:
732-932-4992
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NOWITZKE
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER OF QA AND PLANNING
Authorized Official Telephone Number:
848-932-4982

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  RUTG00510 , 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: 1089402 . This is a "KEYSTONE MERCY ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 23209 . This is a "AMERICAID PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: A598426 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0603537 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 21010 . This is a "UNIVERSITY HEALTH PLAN ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NJ6758 . This is a "HEALTHNET PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 23209 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7190409 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1089402 . This is a "HORIZON NJ HEALTH ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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