Healthcare Provider Details

I. General information

NPI: 1679880983
Provider Name (Legal Business Name): RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 SENIOR ST
NEW BRUNSWICK NJ
08901-8534
US

IV. Provider business mailing address

PO BOX 168007
IRVING TX
75016-8007
US

V. Phone/Fax

Practice location:
  • Phone: 732-932-7884
  • Fax: 732-932-8278
Mailing address:
  • Phone: 866-890-6390
  • Fax: 469-735-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MELODEE LASKY
Title or Position: DIRECTOR, HEALTH SVC
Credential: MD
Phone: 732-932-7402