1699365445 NPI number — RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY

Table of content: (NPI 1699365445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699365445 NPI number — RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY
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:
6
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:
1699365445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 S ORANGE AVE # MSBF656
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07103-2757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-972-3170
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 WARREN STREET
Provider Second Line Business Practice Location Address:
RBL 2140
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-972-3170
Provider Business Practice Location Address Fax Number:
973-972-0795
Provider Enumeration Date:
01/25/2021

Additional Information

Authorized Official

Authorized Official Last Name:
STRECK
Authorized Official First Name:
DEANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
LABORATORY SUPERVISOR
Authorized Official Telephone Number:
973-972-3170

Provider Taxonomy Codes

  • Taxonomy code: 207SM0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 31D2184476 . This is a "CLIA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com