Provider Demographics
NPI:1710117437
Name:RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
Entity Type:Organization
Organization Name:RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
Other - Org Name:RUTGERS UNIVERSITY SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATHLETIC INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEITNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-445-6258
Mailing Address - Street 1:PO BOX 168007
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75016-8007
Mailing Address - Country:US
Mailing Address - Phone:866-890-6390
Mailing Address - Fax:325-437-8390
Practice Address - Street 1:1 SCARLET KNIGHT WAY
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-8069
Practice Address - Country:US
Practice Address - Phone:732-445-6258
Practice Address - Fax:732-445-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty