Healthcare Provider Details

I. General information

NPI: 1609054220
Provider Name (Legal Business Name): UNIVERSITY PHYSICIAN ASSOCIATES OF NEW JERSEY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BERGEN ST ADMC 12 1205
NEWARK NJ
07107-3000
US

IV. Provider business mailing address

30 BERGEN ST ADMC 12 1205
NEWARK NJ
07107-3000
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-0037
  • Fax: 973-972-9355
Mailing address:
  • Phone: 973-972-0037
  • Fax: 973-972-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DAVID HAIER
Title or Position: CEO
Credential:
Phone: 973-972-9503