Provider Demographics
NPI:1518352855
Name:RICHMOND UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:RICHMOND UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR OBSTETRICS AND GYN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-818-1365
Mailing Address - Street 1:1 CARRIAGE CITY PLZ
Mailing Address - Street 2:APT 1116
Mailing Address - City:RAHWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07065-5181
Mailing Address - Country:US
Mailing Address - Phone:817-308-2521
Mailing Address - Fax:
Practice Address - Street 1:355 BARD AVE RICHMOND UNIVERSITY MEDICAL CENTER,
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310
Practice Address - Country:US
Practice Address - Phone:718-818-4273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital