Provider Demographics
NPI:1952449399
Name:RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
Entity Type:Organization
Organization Name:RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
Other - Org Name:RUTGERS EMERGENCY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF QA AND PLANNING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWITZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-932-4982
Mailing Address - Street 1:PO BOX 1077
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08855-1077
Mailing Address - Country:US
Mailing Address - Phone:848-932-4982
Mailing Address - Fax:732-932-4992
Practice Address - Street 1:55 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2786
Practice Address - Country:US
Practice Address - Phone:848-932-4982
Practice Address - Fax:732-932-4992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTGERS STATE UNIVERSITY OF NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-01
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRUTG005103416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1089402OtherKEYSTONE MERCY ID #
NJ23209OtherAMERICAID PROVIDER NUMBER
NJA598426OtherOXFORD
NJ0603537OtherAETNA PROVIDER NUMBER
NJ21010OtherUNIVERSITY HEALTH PLAN ID
NJNJ6758OtherHEALTHNET PROVIDER NUMBER
NJ23209OtherAMERIGROUP
NJ7190409Medicaid
NJ1089402OtherHORIZON NJ HEALTH ID #
NJ1089402OtherHORIZON NJ HEALTH ID #
NJ7190409Medicaid