Healthcare Provider Details

I. General information

NPI: 1992118137
Provider Name (Legal Business Name): ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 REHILL AVE ATTENTION: SOMERSET FAMILY PRACTICE
SOMERVILLE NJ
08876-2519
US

IV. Provider business mailing address

110 REHILL AVE ADMINISTRATIVE OFFICE, ATTENTION: CFO
SOMERVILLE NJ
08876-2519
US

V. Phone/Fax

Practice location:
  • Phone: 908-685-2900
  • Fax: 908-704-0083
Mailing address:
  • Phone: 732-937-8537
  • Fax: 732-937-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11802
License Number StateNJ

VIII. Authorized Official

Name: MR. BRIAN M. REILLY
Title or Position: SR VP FINANCE & CFO
Credential:
Phone: 732-418-8346