=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487853248
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUTGERS SCHOOL OF DENTAL MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2007
-----------------------------------------------------
Last Update Date | 06/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 BERGEN ST
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07103-2495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-973-8668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 BERGEN STREET B842A
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07103-2495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-972-4242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR MGR BILLING & COLLECTIONS OFFICE
-----------------------------------------------------
Name | ROSEMARIE VACCARO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-972-4633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------