Healthcare Provider Details

I. General information

NPI: 1669757217
Provider Name (Legal Business Name): TRINITAS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 WALNUT AVE SUITE 202
CLARK NJ
07066-1640
US

IV. Provider business mailing address

67 WALNUT AVE SUITE 202
CLARK NJ
07066-1640
US

V. Phone/Fax

Practice location:
  • Phone: 732-388-7300
  • Fax: 732-388-1330
Mailing address:
  • Phone: 732-388-7300
  • Fax: 732-388-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB27483
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA08379100
License Number StateNJ

VIII. Authorized Official

Name: MR. THOMAS J SAMPSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 908-298-0579