Provider Demographics
NPI:1710475322
Name:RUTGERS NURSING FACULTY PRACTICE
Entity Type:Organization
Organization Name:RUTGERS NURSING FACULTY PRACTICE
Other - Org Name:RUTGERS COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VONNESSEN-SCANLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-357-7460
Mailing Address - Street 1:PO BOX 829766
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-9766
Mailing Address - Country:US
Mailing Address - Phone:732-235-6057
Mailing Address - Fax:732-235-7446
Practice Address - Street 1:449 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-3224
Practice Address - Country:US
Practice Address - Phone:973-732-6040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)