Provider Demographics
NPI:1942217054
Name:RUTGERS HEALTH - UNIVERSITY BEHAVIORAL HEALTH CARE
Entity Type:Organization
Organization Name:RUTGERS HEALTH - UNIVERSITY BEHAVIORAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:W
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-235-5940
Mailing Address - Street 1:671 HOES LN
Mailing Address - Street 2:P.O. BOX 1392
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-5627
Mailing Address - Country:US
Mailing Address - Phone:732-235-3493
Mailing Address - Fax:732-235-2101
Practice Address - Street 1:671 HOES LN
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5627
Practice Address - Country:US
Practice Address - Phone:732-235-3493
Practice Address - Fax:732-235-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22328283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4144007Medicaid
NJ4144007Medicaid