MEDICARE: GREENVILLE HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	10903	NJ

General Provider Information

NPI Number	:	1639233257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENVILLE HOSPITAL

Provider Business Mailing Address
First Line	:	55 MEADOWLANDS PKWY
Second Line	:	2ND FLOOR FINANCE DEPARTMENT
City	:	SECAUCUS
State	:	NJ
Zip	:	07094-2977
Country	:	US
Telephone Number	:	201-770-3709
Fax Number	:	201-770-3750

Provider Business Practice Location Address
First Line	:	1825 KENNEDY BLVD
Second Line	:	EXECUTIVE OFFICE
City	:	JERSEY CITY
State	:	NJ
Zip	:	07305-2106
Country	:	US
Telephone Number	:	201-770-3709
Fax Number	:	201-770-3750

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. PAUL GOLDBERG
Credential	:
Telephone Number	:	201-521-5920

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	04/29/2011

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Directions to “GREENVILLE HOSPITAL ” Practice Location

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