1801966023 NPI number — RUTGERS, THE STATE UNIV

Table of content: (NPI 1801966023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801966023 NPI number — RUTGERS, THE STATE UNIV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUTGERS, THE STATE UNIV
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:
RUTGERS HEALTH CENTER PHARMACY
Provider Other Organization Name Type Code:
5
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:
1801966023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/03/2008
NPI Reactivation Date:
08/05/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 DAVIDSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PISCATAWAY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-445-2054
Provider Business Mailing Address Fax Number:
732-445-5922

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 BISHOP PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901-1178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-932-8033
Provider Business Practice Location Address Fax Number:
732-932-8641
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARABEDIAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
TAX DIRECTOR
Authorized Official Telephone Number:
732-445-2054

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  28RS00234700 , 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: 3121162 . This is a "NCPDP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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