Provider Demographics
NPI:1043457955
Name:NEWARK BETH ISRAEL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:NEWARK BETH ISRAEL MEDICAL CENTER INC
Other - Org Name:NEWARK BETH ISRAEL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:923-926-7850
Mailing Address - Street 1:201 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-2027
Mailing Address - Country:US
Mailing Address - Phone:732-923-5000
Mailing Address - Fax:973-926-8371
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7000
Practice Address - Fax:973-926-8371
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RWJ BARNABAS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273R00000X, 282N00000X, 283Q00000X
NJ10709273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No282N00000XHospitalsGeneral Acute Care Hospital
No283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4135008Medicaid
31S002Medicare Oscar/Certification
NJ31S002Medicare Oscar/Certification