Healthcare Provider Details

I. General information

NPI: 1396886297
Provider Name (Legal Business Name): CHILDREN'S SPECIALIZED HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOMERSET ST
NEW BRUNSWICK NJ
08901-1942
US

IV. Provider business mailing address

150 NEW PROVIDENCE RD
MOUNTAINSIDE NJ
07092-2590
US

V. Phone/Fax

Practice location:
  • Phone: 732-258-7000
  • Fax: 908-301-5456
Mailing address:
  • Phone: 888-244-5373
  • Fax: 732-258-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22249
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number204140804
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number20703
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number22249
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number2248
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number28RS00417300
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number28RS00675200
License Number StateNJ
# 8
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number22249
License Number StateNJ

VIII. Authorized Official

Name: GERIANN SWENARTON
Title or Position: VP & SITE FINANCIAL OFFICER
Credential:
Phone: 732-501-7052