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General NPI Number Information
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NPI Number | 1588927370
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Entity Type | Organization
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Legal Business Name | UMDNJ-RWJ MEDICAL GROUP
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 125 PATERSON ST 6176
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1962
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Country | US
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Telephone | 732-235-6423
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Fax | 732-235-6530
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Provider Business Mailing Address
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Address Line | 125 PATERSON ST 6176
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-1962
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Country | US
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Telephone | 732-235-6423
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Fax | 732-235-6530
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Authorized Official
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Title or Position | APN
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Name | MS. JACQUELINE GREEN
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Credential |
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Telephone | 732-235-6423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 26NJ00007600
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License Number State | NJ
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