Provider Demographics
NPI:1821464397
Name:THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
Entity Type:Organization
Organization Name:THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
Other - Org Name:PRUDENTIAL HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CRIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-802-9670
Mailing Address - Street 1:213 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-2917
Mailing Address - Country:US
Mailing Address - Phone:973-802-2552
Mailing Address - Fax:973-802-2276
Practice Address - Street 1:213 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-2917
Practice Address - Country:US
Practice Address - Phone:973-802-2552
Practice Address - Fax:973-802-2276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PRUDENTIAL INSURANCE OF AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health