Provider Demographics
NPI:1467688184
Name:JERSEY CITY MEDICAL CENTER
Entity Type:Organization
Organization Name:JERSEY CITY MEDICAL CENTER
Other - Org Name:JERSEY CITY MED CNTR DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-521-5920
Mailing Address - Street 1:355 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4321
Mailing Address - Country:US
Mailing Address - Phone:201-770-3709
Mailing Address - Fax:201-770-3750
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:EXECUTIVE OFFICE
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-770-3709
Practice Address - Fax:201-770-3750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERSEY CITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-09
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10904261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ312310Medicare PIN