Provider Demographics
NPI:1376809996
Name:UMDNJ
Entity Type:Organization
Organization Name:UMDNJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PGY2
Authorized Official - Prefix:DR
Authorized Official - First Name:ANASTASIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHYSTSIAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-527-5501
Mailing Address - Street 1:600 12TH STR APT 906
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-2086
Mailing Address - Country:US
Mailing Address - Phone:201-527-5501
Mailing Address - Fax:
Practice Address - Street 1:600 12TH STR APT 906
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-2086
Practice Address - Country:US
Practice Address - Phone:201-527-5501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren