Provider Demographics
NPI:1376079590
Name:SAINT PETER'S UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:SAINT PETER'S UNIVERSITY HOSPITAL
Other - Org Name:SAINT PETER'S BEHAVIORAL HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:MS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-565-5453
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:MANAGED CARE
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-565-5453
Mailing Address - Fax:732-249-9572
Practice Address - Street 1:254 EASTON AVE
Practice Address - Street 2:MANAGED CARE
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1766
Practice Address - Country:US
Practice Address - Phone:732-565-5453
Practice Address - Fax:732-249-9572
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT PETER'S UNIVERSITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty