Provider Demographics
NPI:1720406200
Name:RUTGERS NEW JERSEY MEDICAL SCHOOL
Entity Type:Organization
Organization Name:RUTGERS NEW JERSEY MEDICAL SCHOOL
Other - Org Name:UNIVERSITY HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SURGICAL PATHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-972-5714
Mailing Address - Street 1:185 S ORANGE AVE
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:973-972-5714
Mailing Address - Fax:973-972-5724
Practice Address - Street 1:185 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2757
Practice Address - Country:US
Practice Address - Phone:973-972-5714
Practice Address - Fax:973-972-5724
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTGERS NEW JERSEY MEDICAL SCHOOL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04208500282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital