Provider Demographics
NPI:1114179025
Name:CLARA MAASS MEDICAL CENTER
Entity Type:Organization
Organization Name:CLARA MAASS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:CLYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-450-2002
Mailing Address - Street 1:1 CLARA MAASS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3550
Mailing Address - Country:US
Mailing Address - Phone:973-450-2000
Mailing Address - Fax:
Practice Address - Street 1:1 CLARA MAASS DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3550
Practice Address - Country:US
Practice Address - Phone:973-450-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RWJ BARNABAS HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-22
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10701273R00000X
NJ273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4135504Medicaid
31S009Medicare Oscar/Certification
NJ4135504Medicaid