Provider Demographics
NPI:1366493041
Name:ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL, INC
Entity Type:Organization
Organization Name:ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-828-3000
Mailing Address - Street 1:1 ROBERT WOOD JOHNSON PL
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1928
Mailing Address - Country:US
Mailing Address - Phone:732-828-3000
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1928
Practice Address - Country:US
Practice Address - Phone:732-828-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROBERT WOOD JOHNSON UH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11202261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4137701Medicaid
NJ312317Medicare Oscar/Certification