Healthcare Provider Details

I. General information

NPI: 1790930816
Provider Name (Legal Business Name): RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 GEORGE ST
NEW BRUNSWICK NJ
08901-1311
US

IV. Provider business mailing address

277 GEORGE ST
NEW BRUNSWICK NJ
08901-1311
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6700
  • Fax: 732-235-6726
Mailing address:
  • Phone: 732-235-6700
  • Fax: 732-235-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number22211
License Number StateNJ

VIII. Authorized Official

Name: SANDRA ADAMS
Title or Position: INTERIM EXECUTIVE DIRECTOR
Credential:
Phone: 732-235-6756