Provider Demographics
NPI:1033494430
Name:UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:UNIVERSITY HOSPITAL
Other - Org Name:UNIVERSITY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:HUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-972-0882
Mailing Address - Street 1:30 BERGEN STREET
Mailing Address - Street 2:ADMC 1327
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-1709
Mailing Address - Country:US
Mailing Address - Phone:973-972-0882
Mailing Address - Fax:973-972-9129
Practice Address - Street 1:205 SOUTH ORANGE AVENUE
Practice Address - Street 2:DEPT. ONCOLOGY B-1245
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2785
Practice Address - Country:US
Practice Address - Phone:973-972-5053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
23-1534Medicare UPIN