Provider Demographics
NPI:1407019185
Name:UNIVERSITY OF MEDICINE & DENTISTRY OF NEW JERSEY
Entity Type:Organization
Organization Name:UNIVERSITY OF MEDICINE & DENTISTRY OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WOMENS HEALTH NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:NP C
Authorized Official - Phone:973-972-9043
Mailing Address - Street 1:150 BERGEN ST
Mailing Address - Street 2:G102 FXB CLINIC
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2496
Mailing Address - Country:US
Mailing Address - Phone:973-972-9043
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN ST
Practice Address - Street 2:G102 FXB CLINIC
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2496
Practice Address - Country:US
Practice Address - Phone:973-972-9043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00156800261Q00000X, 282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center