Provider Demographics
NPI:1790930816
Name:RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER
Entity Type:Organization
Organization Name:RUTGERS RWJ ERIC B. CHANDLER HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-235-6756
Mailing Address - Street 1:277 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1311
Mailing Address - Country:US
Mailing Address - Phone:732-235-6700
Mailing Address - Fax:732-235-6726
Practice Address - Street 1:277 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1311
Practice Address - Country:US
Practice Address - Phone:732-235-6700
Practice Address - Fax:732-235-6726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTGERS THE STATE UNIVERSITY OF NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-18
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22211261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0043419Medicaid
NJ0043419Medicaid