Provider Demographics
NPI:1770644692
Name:TRINITAS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:TRINITAS REGIONAL MEDICAL CENTER
Other - Org Name:TRINITAS HOSPITAL-FAMILY RESOURCE CTR.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-994-5000
Mailing Address - Street 1:300 NORTH AVE E
Mailing Address - Street 2:FAMILY RESOURCE CENTER
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2435
Mailing Address - Country:US
Mailing Address - Phone:908-994-2244
Mailing Address - Fax:
Practice Address - Street 1:300 NORTH AVE E
Practice Address - Street 2:FAMILY RESOURCE CENTER
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2435
Practice Address - Country:US
Practice Address - Phone:908-994-2244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITAS REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TC0700X, 174400000X, 207Q00000X
NJ12007282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4136900Medicaid
NJ310027Medicare ID - Type Unspecified