Provider Demographics
NPI: | 1265012660 |
---|---|
Name: | ROBERT WOOD JOHNSON MEDICAL ASSOCIATES AT HAMILTON PA |
Entity Type: | Organization |
Organization Name: | ROBERT WOOD JOHNSON MEDICAL ASSOCIATES AT HAMILTON PA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF FINANCE |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JACQUELINE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MINTZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 732-369-5967 |
Mailing Address - Street 1: | PO BOX 352 |
Mailing Address - Street 2: | |
Mailing Address - City: | LINDEN |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07036-0352 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 908-925-7519 |
Mailing Address - Fax: | 908-925-2842 |
Practice Address - Street 1: | 210 MEADOWLANDS PKWY |
Practice Address - Street 2: | |
Practice Address - City: | SECAUCUS |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07094-2311 |
Practice Address - Country: | US |
Practice Address - Phone: | 201-348-3636 |
Practice Address - Fax: | 201-583-0713 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-04-09 |
Last Update Date: | 2021-04-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty |