Provider Demographics
NPI:1720363955
Name:TRINITAS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:TRINITAS REGIONAL MEDICAL CENTER
Other - Org Name:TRINITAS REGIONAL MEDICAL CENTER PHYSICIANS PRACTICE ACCT LINDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-298-0579
Mailing Address - Street 1:901 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4039
Mailing Address - Country:US
Mailing Address - Phone:908-925-2422
Mailing Address - Fax:908-925-4435
Practice Address - Street 1:901 N WOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4039
Practice Address - Country:US
Practice Address - Phone:908-925-2422
Practice Address - Fax:908-925-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB06715700207R00000X
NJ25MA08379100207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty