Provider Demographics
NPI:1942452602
Name:UMDNJ - SCHOOL OF HEALTH RELATED PROFESSIONS
Entity Type:Organization
Organization Name:UMDNJ - SCHOOL OF HEALTH RELATED PROFESSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR FACULTY PERSONNEL ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:LECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-972-4496
Mailing Address - Street 1:65 BERGEN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-3001
Mailing Address - Country:US
Mailing Address - Phone:973-972-4496
Mailing Address - Fax:
Practice Address - Street 1:65 BERGEN ST STE 120
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-3001
Practice Address - Country:US
Practice Address - Phone:973-972-4496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI00436800261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental