MEDICARE: RUTGERS HEALTH - UNIVERSITY BEHAVIORAL HEALTH CARE

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	283Q00000X	Psychiatric Hospital	22328	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942217054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUTGERS HEALTH - UNIVERSITY BEHAVIORAL HEALTH CARE

Provider Business Mailing Address
First Line	:	671 HOES LN
Second Line	:	P.O. BOX 1392
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-5627
Country	:	US
Telephone Number	:	732-235-3493
Fax Number	:	732-235-2101

Provider Business Practice Location Address
First Line	:	671 HOES LN
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-5627
Country	:	US
Telephone Number	:	732-235-3493
Fax Number	:	732-235-2101

Authorized Official
Title or Position	:	CFO
Name	:	MR. CARL W. O'BRIEN
Credential	:
Telephone Number	:	732-235-5940

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/31/2017

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