Healthcare Provider Details

I. General information

NPI: 1417955485
Provider Name (Legal Business Name): SAINT BARNABAS OUTPATIENT CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ORANGE AVE
LIVINGSTON NJ
07039-5817
US

IV. Provider business mailing address

1050 GALLOPING HILL RD
UNION NJ
07083-7983
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-7909
  • Fax: 973-322-7776
Mailing address:
  • Phone: 908-206-2230
  • Fax: 908-206-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number70786
License Number StateNJ

VIII. Authorized Official

Name: MR. GREGORY A. ALBAN
Title or Position: AVP OF FINANCE
Credential:
Phone: 973-322-7331