Provider Demographics
NPI:1376748103
Name:UMDNJ RWJ OBGYN
Entity Type:Organization
Organization Name:UMDNJ RWJ OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-235-5335
Mailing Address - Street 1:125 PATERSON ST
Mailing Address - Street 2:STE. 2142
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1962
Mailing Address - Country:US
Mailing Address - Phone:732-253-3892
Mailing Address - Fax:
Practice Address - Street 1:1 ROBERT WOOD JOHNSON PL
Practice Address - Street 2:HIGH RISK CLINIC ATRIUM
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1928
Practice Address - Country:US
Practice Address - Phone:732-253-3892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNR05721700363LP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatalGroup - Multi-Specialty