Provider Demographics
NPI:1477787737
Name:UNIVERSITY OF MEDICINE AND DENSITRY
Entity Type:Organization
Organization Name:UNIVERSITY OF MEDICINE AND DENSITRY
Other - Org Name:UMDNJ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ASSISTANT DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMIENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, APN
Authorized Official - Phone:973-972-7451
Mailing Address - Street 1:65 BERGEN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3001
Mailing Address - Country:US
Mailing Address - Phone:973-972-9793
Mailing Address - Fax:973-972-7904
Practice Address - Street 1:65 BERGEN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-3001
Practice Address - Country:US
Practice Address - Phone:973-972-9793
Practice Address - Fax:973-972-7904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR09200200261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center