MEDICARE: COMMUNITY HOSPITAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	22293	NJ

General Provider Information

NPI Number	:	1649498429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HOSPITAL GROUP, INC

Provider Business Mailing Address
First Line	:	80 JAMES ST
Second Line	:	4TH FLOOR
City	:	EDISON
State	:	NJ
Zip	:	08820-3938
Country	:	US
Telephone Number	:	732-632-1571
Fax Number	:	732-632-1644

Provider Business Practice Location Address
First Line	:	80 JAMES ST
Second Line	:	4TH FLOOR
City	:	EDISON
State	:	NJ
Zip	:	08820-3938
Country	:	US
Telephone Number	:	732-632-1571
Fax Number	:	732-632-1644

Authorized Official
Title or Position	:	CFO
Name	:	MR. RICHARD C SMITH
Credential	:
Telephone Number	:	732-321-7000

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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