=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306659560
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF ELIZABETH DEPARTMENT OF HEALTH AND HUMAN SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2025
-----------------------------------------------------
Last Update Date | 01/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 WINFIELD SCOTT PLAZA
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07201-2462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-820-4089
-----------------------------------------------------
Fax | 908-820-4290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 WINFIELD SCOTT PLAZA ROOM G5
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07201-2462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-820-4089
-----------------------------------------------------
Fax | 908-820-4290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MAYOR
-----------------------------------------------------
Name | J. CHRISTIAN BOLLWAGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-820-4170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223D0001X
-----------------------------------------------------
Taxonomy Name | Public Health Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 347B00000X
-----------------------------------------------------
Taxonomy Name | Bus
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------