Provider Demographics
NPI:1619916574
Name:RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER
Entity Type:Organization
Organization Name:RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-235-6756
Mailing Address - Street 1:277 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1311
Mailing Address - Country:US
Mailing Address - Phone:732-235-6700
Mailing Address - Fax:732-235-6726
Practice Address - Street 1:123 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2001
Practice Address - Country:US
Practice Address - Phone:732-235-6700
Practice Address - Fax:732-235-6726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTGERS THE STATE UNIVERSITY OF NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-06
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ24001261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0101184Medicaid
NJ311867Medicare Oscar/Certification