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General NPI Number Information
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NPI Number | 1700968187
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Entity Type | Organization
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Legal Business Name | RUTGERS HEALTH-RWJ SCLERODERMA PROGRAM
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 671 HOES LN
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City | PISCATAWAY
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State | NJ
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Zip | 08854-5627
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Country | US
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Telephone | 732-235-4402
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Fax | 732-235-4430
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Provider Business Mailing Address
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Address Line | 66 W GILBERT ST
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City | RED BAML
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State | NJ
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Zip | 07701
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Country | US
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Telephone | 732-212-0051
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Fax | 732-212-0713
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE CYCLE
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Name | BRENDA SUSAN LAWRENCE
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Credential |
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Telephone | 732-235-6070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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