Provider Demographics
NPI:1629165204
Name:TRINITAS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:TRINITAS REGIONAL MEDICAL CENTER
Other - Org Name:TRINITAS HOSPITAL-YOUTH CASE MANAGEMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN BILLING
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-994-8068
Mailing Address - Street 1:225 WILLIAMSON STREET
Mailing Address - Street 2:PHYSICIAN BILLING
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07207
Mailing Address - Country:US
Mailing Address - Phone:908-994-8068
Mailing Address - Fax:
Practice Address - Street 1:655 E JERSEY STREET
Practice Address - Street 2:YOUTH CASE MANAGEMENT
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206
Practice Address - Country:US
Practice Address - Phone:908-994-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITAL REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12007282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023302Medicaid