Provider Demographics
NPI:1639233257
Name:GREENVILLE HOSPITAL
Entity Type:Organization
Organization Name:GREENVILLE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-521-5920
Mailing Address - Street 1:55 MEADOWLANDS PKWY
Mailing Address - Street 2:2ND FLOOR FINANCE DEPARTMENT
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2977
Mailing Address - Country:US
Mailing Address - Phone:201-770-3709
Mailing Address - Fax:201-770-3750
Practice Address - Street 1:1825 KENNEDY BLVD
Practice Address - Street 2:EXECUTIVE OFFICE
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2106
Practice Address - Country:US
Practice Address - Phone:201-770-3709
Practice Address - Fax:201-770-3750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENVILLE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-20
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10903261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ312310Medicare ID - Type Unspecified