Provider Demographics
NPI:1225383342
Name:ST. JOSEPH'S REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:ST. JOSEPH'S REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:AI HUNG
Authorized Official - Last Name:PENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-559-3850
Mailing Address - Street 1:40 BRUAN PL
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-5343
Mailing Address - Country:US
Mailing Address - Phone:347-559-3850
Mailing Address - Fax:
Practice Address - Street 1:40 BRUAN PL
Practice Address - Street 2:APARTMENT A
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-5343
Practice Address - Country:US
Practice Address - Phone:347-559-3850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-15
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
#39282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital