Healthcare Provider Details

I. General information

NPI: 1376079590
Provider Name (Legal Business Name): SAINT PETER'S UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2017
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 EASTON AVE MANAGED CARE
NEW BRUNSWICK NJ
08901-1766
US

IV. Provider business mailing address

254 EASTON AVE MANAGED CARE
NEW BRUNSWICK NJ
08901-1766
US

V. Phone/Fax

Practice location:
  • Phone: 732-565-5453
  • Fax: 732-249-9572
Mailing address:
  • Phone: 732-565-5453
  • Fax: 732-249-9572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. STACEY A KNOWLES
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 732-565-5453