Healthcare Provider Details

I. General information

NPI: 1801274634
Provider Name (Legal Business Name): ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SULLIVAN WAY COTTAGE 1
EWING NJ
08628-3405
US

IV. Provider business mailing address

703 MAIN ST
PATERSON NJ
07503-2621
US

V. Phone/Fax

Practice location:
  • Phone: 609-643-5805
  • Fax: 609-643-5507
Mailing address:
  • Phone: 973-754-2000
  • Fax: 973-754-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOANNE DUNAY
Title or Position: CONTROLLER
Credential:
Phone: 973-754-2016