Provider Demographics
NPI:1205047651
Name:UMDNJ UNIVERSITY HOSPITAL
Entity type:Organization
Organization Name:UMDNJ UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:GALAINI
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:973-972-2153
Mailing Address - Street 1:DOCTOR'S OFFICE CENTER, SUITE 1200
Mailing Address - Street 2:90 BERGEN ST.
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-972-2153
Mailing Address - Fax:973-972-5296
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:ACC SUITE D1610
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-2153
Practice Address - Fax:973-972-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00003300282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital