Healthcare Provider Details

I. General information

NPI: 1639210180
Provider Name (Legal Business Name): CHILDRENS SPECIALIZED HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NEW PROVIDENCE RD
MOUNTAINSIDE NJ
07092-2590
US

IV. Provider business mailing address

150 NEW PROVIDENCE RD
MOUNTAINSIDE NJ
07092-2590
US

V. Phone/Fax

Practice location:
  • Phone: 908-233-3720
  • Fax: 908-301-5456
Mailing address:
  • Phone: 908-233-3720
  • Fax: 908-301-5456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number22249
License Number StateNJ

VIII. Authorized Official

Name: MR. JOSEPH J DOBOSH JR.
Title or Position: VP, FINANCE & CFO
Credential:
Phone: 908-301-5455