Provider Demographics
NPI:1497143440
Name:ST MICHAEL'S MEDICAL CENTER
Entity Type:Organization
Organization Name:ST MICHAEL'S MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AOA INTERNAL MEDICINE RESIDENCY DIR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-892-9839
Mailing Address - Street 1:110 NEWARK AVE APT F6
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4129
Mailing Address - Country:US
Mailing Address - Phone:503-515-3167
Mailing Address - Fax:
Practice Address - Street 1:110 NEWARK AVE APT F6
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4129
Practice Address - Country:US
Practice Address - Phone:503-515-3167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP13-00379OtherRESIDENCY TRAINING PERMIT