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General NPI Number Information
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NPI Number | 1699365445
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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 | 01/25/2021
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 225 WARREN STREET RBL 2140
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City | NEWARK
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State | NJ
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Zip | 07103
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Country | US
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Telephone | 973-972-3170
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Fax | 973-972-0795
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Provider Business Mailing Address
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Address Line | 185 S ORANGE AVE # MSBF656
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City | NEWARK
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State | NJ
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Zip | 07103-2757
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Country | US
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Telephone | 973-972-3170
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Fax |
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Authorized Official
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Title or Position | LABORATORY SUPERVISOR
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Name | DEANNA STRECK
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Credential |
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Telephone | 973-972-3170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SM0001X
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Taxonomy Name | Molecular Genetic Pathology (Medical Genetics) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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