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General NPI Number Information
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NPI Number | 1679880983
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Entity Type | Organization
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Legal Business Name | RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 17 SENIOR ST
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-8534
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Country | US
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Telephone | 732-932-7884
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Fax | 732-932-8278
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Provider Business Mailing Address
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Address Line | PO BOX 168007
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City | IRVING
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State | TX
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Zip | 75016-8007
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Country | US
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Telephone | 866-890-6390
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Fax | 469-735-4640
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Authorized Official
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Title or Position | DIRECTOR, HEALTH SVC
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Name | MELODEE LASKY
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Credential | MD
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Telephone | 732-932-7402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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