Healthcare Provider Details

I. General information

NPI: 1548213424
Provider Name (Legal Business Name): UMDNJ RWJ UNIV ORTHOPAEDIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 EASTON AVE
NEW BRUNSWICK NJ
08901-1722
US

IV. Provider business mailing address

66 W GILBERT ST
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 732-545-0400
  • Fax: 732-545-0465
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CAROLE PENZYNSKI
Title or Position: CREDENTIALS MANAGER
Credential:
Phone: 732-212-0061