Provider Demographics
NPI:1770662017
Name:LIBERTY RIVERSIDE HEALTHCARE
Entity Type:Organization
Organization Name:LIBERTY RIVERSIDE HEALTHCARE
Other - Org Name:MEADOWLANDS HOSPITAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-521-5920
Mailing Address - Street 1:1 HARMON MEADOW BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3600
Mailing Address - Country:US
Mailing Address - Phone:201-770-3709
Mailing Address - Fax:201-770-3750
Practice Address - Street 1:55 MEADOWLANDS PKWY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2977
Practice Address - Country:US
Practice Address - Phone:201-770-3709
Practice Address - Fax:201-770-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10906282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0004391000OtherAMERIHEALTH
NJ310118OtherBLUE CROSS
NJ0014073OtherAETNAUS HEALTHCARE
NJ1012468OtherHORIZON NJ HLTHCARE MERCY
NJ1014065OtherHORIZON NJ HLTHCARE MERCY
NJ4141504OtherCHARITY CARE
NJ1015732OtherHORIZON NJ HLTHCARE MERCY
NJ1015733OtherHORIZON NJ HLTHCARE MERCY
NJ4141504Medicaid
NJ50082OtherAMERIGROUP AMERICAID
NJJ30955OtherHEALTH PHS
NJ310118OtherANTHEM GROUP NEW JERSEY
NJ1012468OtherHORIZON NJ HLTHCARE MERCY
NJ1014065OtherHORIZON NJ HLTHCARE MERCY