Provider Demographics
NPI:1114924834
Name:SAINT PETER'S UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:SAINT PETER'S UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:STOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-745-6651
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-6651
Mailing Address - Fax:732-745-7938
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-745-6651
Practice Address - Fax:732-745-7938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT PETER'S HEALTHCARE SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11205282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4139500Medicaid
NJ4139500Medicaid
NJ310070Medicare Oscar/Certification