Healthcare Provider Details

I. General information

NPI: 1366676702
Provider Name (Legal Business Name): SETON HALL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S ORANGE AVE
SOUTH ORANGE NJ
07079-2646
US

IV. Provider business mailing address

400 S ORANGE AVE
SOUTH ORANGE NJ
07079-2646
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-9175
  • Fax: 973-761-9193
Mailing address:
  • Phone: 973-761-9175
  • Fax: 973-761-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOAN OSTHUES
Title or Position: DIRECTOR, HEALTH SERVICES
Credential:
Phone: 973-761-9175