=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366888562
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLANTIC HEALTH SYSTEM INC (MORRISTOWN MEDICAL CENTER)
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2013
-----------------------------------------------------
Last Update Date | 02/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MADISON AVE
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07960-6136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-971-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1106 MIDDLESEX ST APPT 1
-----------------------------------------------------
City | LINDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07036-1849
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-220-4142
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GME COORDINATOR
-----------------------------------------------------
Name | MRS. MICHELLE KAMMERER-JEROME
-----------------------------------------------------
Credential | BA
-----------------------------------------------------
Telephone | 973-971-4102
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------