Healthcare Provider Details

I. General information

NPI: 1467645952
Provider Name (Legal Business Name): HUMC OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122-132 CLINTON ST
HOBOKEN NJ
07030-8519
US

IV. Provider business mailing address

PO BOX 48309
NEWARK NJ
07101-4800
US

V. Phone/Fax

Practice location:
  • Phone: 201-418-3109
  • Fax: 201-418-3147
Mailing address:
  • Phone: 201-418-3109
  • Fax: 201-418-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number10908
License Number StateNJ

VIII. Authorized Official

Name: MR. VINCENT RICCITELI
Title or Position: VP FINANCE
Credential:
Phone: 201-418-2184