Healthcare Provider Details

I. General information

NPI: 1225240997
Provider Name (Legal Business Name): JEWISH RENAISSANCE MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOBART ST
PERTH AMBOY NJ
08861
US

IV. Provider business mailing address

PO BOX 1220
PERTH AMBOY NJ
08862-1220
US

V. Phone/Fax

Practice location:
  • Phone: 732-376-6615
  • Fax:
Mailing address:
  • Phone: 732-376-6615
  • Fax: 732-324-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number23977
License Number StateNJ

VIII. Authorized Official

Name: MARTA FERREIRA
Title or Position: DIRECTOR OF HR
Credential:
Phone: 732-376-6615