Healthcare Provider Details

I. General information

NPI: 1679583272
Provider Name (Legal Business Name): UNIVERSITY PHYSICIAN ASSOCIATES OF NEW JERSEY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERGEN ST
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 973-972-2100
  • Fax:
Mailing address:
  • Phone: 973-972-0037
  • Fax: 973-972-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2814773
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

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