Healthcare Provider Details

I. General information

NPI: 1053860213
Provider Name (Legal Business Name): RWJBARNABAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 JERSEY AVE 220
JERSEY CITY NJ
07302-4393
US

IV. Provider business mailing address

377 JERSEY AVE 220
JERSEY CITY NJ
07302-4393
US

V. Phone/Fax

Practice location:
  • Phone: 201-309-2380
  • Fax: 201-309-2381
Mailing address:
  • Phone: 201-309-2380
  • Fax: 201-309-2381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number25MA09112900
License Number StateNJ

VIII. Authorized Official

Name: MR. VALENTIN MARIAN
Title or Position: RHEUMATOLOGIST
Credential: MD
Phone: 201-309-2380