Healthcare Provider Details

I. General information

NPI: 1477304541
Provider Name (Legal Business Name): ST JOSEPHS UNIVERSITY MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 03/28/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN STREET REGAN BUILDING BASEMENT, RM RB37
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

703 MAIN STREET REGAN BUILDING BASEMENT, RM RB37
PATERSON NJ
07503-2621
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-5640
  • Fax: 973-754-3095
Mailing address:
  • Phone: 973-754-5640
  • Fax: 973-754-3095

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: DUSTIN MICHAEL RICCIO
Title or Position: CEO
Credential: MD
Phone: 585-368-6419