Provider Demographics
NPI:1629306725
Name:UMDNJ NEW JERSEY MEDICAL SCHOOL
Entity Type:Organization
Organization Name:UMDNJ NEW JERSEY MEDICAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:RETEGUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-972-6076
Mailing Address - Street 1:231 WILSON AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3031
Mailing Address - Country:US
Mailing Address - Phone:517-303-3120
Mailing Address - Fax:
Practice Address - Street 1:231 WILSON AVE FL 1
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-3031
Practice Address - Country:US
Practice Address - Phone:517-303-3120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital