Provider Demographics
NPI:1962464255
Name:SAINT BARNABAS OUTPATIENT CENTERS
Entity Type:Organization
Organization Name:SAINT BARNABAS OUTPATIENT CENTERS
Other - Org Name:MULTIPLE SCLEROSIS COMPREHENSIVE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-322-7331
Mailing Address - Street 1:1050 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7983
Mailing Address - Country:US
Mailing Address - Phone:908-206-2230
Mailing Address - Fax:908-206-2237
Practice Address - Street 1:200 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-322-7484
Practice Address - Fax:973-322-8250
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT BARNABAS OUTPATIENT CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-04
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA046002002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0107158Medicaid
NJ099678Medicare Oscar/Certification