Provider Demographics
NPI:1225251754
Name:COMMUNITY HOSPITAL GROUP INC
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL GROUP INC
Other - Org Name:JRI PHYSICAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-321-7000
Mailing Address - Street 1:80 JAMES ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3938
Mailing Address - Country:US
Mailing Address - Phone:732-632-1571
Mailing Address - Fax:732-632-1644
Practice Address - Street 1:80 JAMES ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3938
Practice Address - Country:US
Practice Address - Phone:732-632-1571
Practice Address - Fax:732-632-1644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HOSPITAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-11
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22293174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9089306Medicaid
NJ7736304Medicaid
NJ9089306Medicaid