=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144643651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINITAS REGIONAL MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2014
-----------------------------------------------------
Last Update Date | 02/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 654 E JERSEY ST
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07206-1261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-994-7290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 654 E JERSEY ST
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07206-1261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-994-7290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OCCURRING CLINICIAN
-----------------------------------------------------
Name | DANIELLE SABESTINAS
-----------------------------------------------------
Credential | LSW
-----------------------------------------------------
Telephone | 908-994-7290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | 44SL05896200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------