Provider Demographics
NPI:1699365445
Name:RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY
Entity Type:Organization
Organization Name:RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY
Other - Org Name:RUTGERS NEW JERSEY MEDICAL SCHOOL EMERGING PATHOGENS CLINICAL LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-972-3170
Mailing Address - Street 1:185 S ORANGE AVE # MSBF656
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2757
Mailing Address - Country:US
Mailing Address - Phone:973-972-3170
Mailing Address - Fax:
Practice Address - Street 1:225 WARREN STREET
Practice Address - Street 2:RBL 2140
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-3170
Practice Address - Fax:973-972-0795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-25
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ31D2184476OtherCLIA