1689744856 NPI number — JERSEY CITY MEDICAL CENTER

Table of content: (NPI 1689744856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689744856 NPI number — JERSEY CITY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERSEY CITY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689744856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 GRAND STREET
Provider Second Line Business Mailing Address:
EXECUTIVE OFFICE
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07302-4321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-770-3712
Provider Business Mailing Address Fax Number:
201-770-3750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 GRAND STREET
Provider Second Line Business Practice Location Address:
EXECUTIVE OFFICE
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07302-4321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-770-3712
Provider Business Practice Location Address Fax Number:
732-923-2272
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRILUTSKY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
201-915-2262

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  10904 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50022 . This is a "AMERIGROUP AMERICAID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J30888 . This is a "HEALTH NET PHS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0014014 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4139801 . This is a "CHARITY CARE UNYSIS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: H05253 . This is a "OXFORD HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 310074 . This is a "ANTHEM GROUP NEW JERSEY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 310074 . This is a "HORIZON BLUE CROSS NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4139801 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004312000 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1015751 . This is a "HORIZON NJ HLTHCARE MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 49068 . This is a "HORIZON NJ HLTHCARE MERCY" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: HU0000048-03 . This is a "AMERICHOICE MHS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1015749 . This is a "HORIZON NJ HLTHCARE MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1015750 . This is a "HORIZON NJ HLTHCARE MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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