Provider Demographics
NPI:1205023132
Name:MERIDIAN HEALTH SYSTEMS
Entity Type:Organization
Organization Name:MERIDIAN HEALTH SYSTEMS
Other - Org Name:JERSEY SHORE UNVERSITY MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GIBILISCO-ZYKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:732-776-2325
Mailing Address - Street 1:1945 CORLIES AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4859
Mailing Address - Country:US
Mailing Address - Phone:732-776-2325
Mailing Address - Fax:732-776-2329
Practice Address - Street 1:1945 CORLIES AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-2325
Practice Address - Fax:732-776-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11987500283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital