MEDICARE: ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER

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	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801274634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER

Provider Business Mailing Address
First Line	:	703 MAIN ST
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07503-2621
Country	:	US
Telephone Number	:	973-754-2000
Fax Number	:	973-754-2149

Provider Business Practice Location Address
First Line	:	320 SULLIVAN WAY
Second Line	:	COTTAGE 1
City	:	EWING
State	:	NJ
Zip	:	08628-3405
Country	:	US
Telephone Number	:	609-643-5805
Fax Number	:	609-643-5507

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MRS. JOANNE DUNAY
Credential	:
Telephone Number	:	973-754-2016

Provider Enumeration Date	:	05/13/2015
Last Update Date	:	03/31/2021

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