Healthcare Provider Details

I. General information

NPI: 1306596390
Provider Name (Legal Business Name): UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN ST STE B1650
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

140 BERGEN ST STE B1650
NEWARK NJ
07103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 888-716-0680
  • Fax: 973-972-1989
Mailing address:
  • Phone: 888-716-0680
  • Fax: 973-972-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOHN GARY HUCK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 973-972-0882