Healthcare Provider Details

I. General information

NPI: 1710475322
Provider Name (Legal Business Name): RUTGERS NURSING FACULTY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 BROAD ST
NEWARK NJ
07102-3224
US

IV. Provider business mailing address

PO BOX 829766
PHILADELPHIA PA
19182-9766
US

V. Phone/Fax

Practice location:
  • Phone: 973-732-6040
  • Fax:
Mailing address:
  • Phone: 732-235-6057
  • Fax: 732-235-7446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BECKFORD
Title or Position: SENIOR BUISNESS MANAGER
Credential:
Phone: 973-353-3693