Provider Demographics
NPI:1043625742
Name:SAINT MICHAELS MEDICAL CENTER
Entity Type:Organization
Organization Name:SAINT MICHAELS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-877-5487
Mailing Address - Street 1:17 RIVER RD APT J
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3466
Mailing Address - Country:US
Mailing Address - Phone:973-493-1951
Mailing Address - Fax:
Practice Address - Street 1:17 RIVER RD APT J
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3466
Practice Address - Country:US
Practice Address - Phone:973-493-1951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital