Healthcare Provider Details

I. General information

NPI: 1295876191
Provider Name (Legal Business Name): CHILDRENS SPECIALIZED HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NEW PROVIDENCE RD
MOUNTAINSIDE NJ
07092-2590
US

IV. Provider business mailing address

PO BOX 15391
NEWARK NJ
07192-5391
US

V. Phone/Fax

Practice location:
  • Phone: 908-233-3720
  • Fax:
Mailing address:
  • Phone: 908-301-5900
  • Fax: 908-301-5934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number22249L
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number28RS00417300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number22248L
License Number StateNJ

VIII. Authorized Official

Name: JOSEPH DOBOSH
Title or Position: VP FINANCE CFO
Credential:
Phone: 908-301-5455