Healthcare Provider Details

I. General information

NPI: 1265509202
Provider Name (Legal Business Name): COMMUNITY HOSPITAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JAMES ST
EDISON NJ
08820-3947
US

IV. Provider business mailing address

80 JAMES ST 4TH FLOOR
EDISON NJ
08820-3938
US

V. Phone/Fax

Practice location:
  • Phone: 732-632-1571
  • Fax: 732-632-1644
Mailing address:
  • Phone: 732-632-1571
  • Fax: 732-632-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number61531
License Number StateNJ

VIII. Authorized Official

Name: MR. RICHARD C SMITH
Title or Position: CHIEF FINANCIAL OFFICE
Credential:
Phone: 732-321-7747