Provider Demographics
NPI:1477304541
Name:ST JOSEPHS UNIVERSITY MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:ST JOSEPHS UNIVERSITY MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RICCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-368-6419
Mailing Address - Street 1:703 MAIN STREET
Mailing Address - Street 2:REGAN BUILDING BASEMENT, RM RB37
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2621
Mailing Address - Country:US
Mailing Address - Phone:973-754-5640
Mailing Address - Fax:973-754-3095
Practice Address - Street 1:703 MAIN STREET
Practice Address - Street 2:REGAN BUILDING BASEMENT, RM RB37
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-5640
Practice Address - Fax:973-754-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy