Healthcare Provider Details

I. General information

NPI: 1497825665
Provider Name (Legal Business Name): JERSEY CITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 10/03/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 GRAND STREET EXECUTIVE OFFICE
JERSEY CITY NJ
07302-4321
US

IV. Provider business mailing address

355 GRAND STREET EXECUTIVE OFFICE
JERSEY CITY NJ
07302-4321
US

V. Phone/Fax

Practice location:
  • Phone: 201-770-3712
  • Fax: 732-923-2272
Mailing address:
  • Phone: 201-770-3712
  • Fax: 201-770-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number10904
License Number StateNJ

VIII. Authorized Official

Name: MR. MICHAEL PRILUTSKY
Title or Position: CEO
Credential:
Phone: 201-915-2262