Provider Demographics
NPI:1023402013
Name:HYACINTH FOUNDATION A NEW JERSEY NONPROFIT CORPORATION
Entity Type:Organization
Organization Name:HYACINTH FOUNDATION A NEW JERSEY NONPROFIT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:AHEARN-O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-246-0204
Mailing Address - Street 1:317 GEORGE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2008
Mailing Address - Country:US
Mailing Address - Phone:732-246-0204
Mailing Address - Fax:732-246-4137
Practice Address - Street 1:317 GEORGE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2008
Practice Address - Country:US
Practice Address - Phone:732-246-0204
Practice Address - Fax:732-246-4137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty