Healthcare Provider Details

I. General information

NPI: 1174539506
Provider Name (Legal Business Name): MUHLENBERG REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARK & RANDOLPH ROAD
PLAINFIELD NJ
07060
US

IV. Provider business mailing address

80 JAMES ST 4TH FLOOR
EDISON NJ
08820-3938
US

V. Phone/Fax

Practice location:
  • Phone: 732-321-7891
  • Fax: 732-632-1676
Mailing address:
  • Phone: 732-321-7891
  • Fax: 732-632-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number12004
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier3675301
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. RICHARD C SMITH
Title or Position: SR. VICE PRESIDENT, CFO
Credential:
Phone: 732-321-7747