Provider Demographics
NPI:1295876191
Name:CHILDRENS SPECIALIZED HOSPITAL
Entity type:Organization
Organization Name:CHILDRENS SPECIALIZED HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-301-5455
Mailing Address - Street 1:PO BOX 15391
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07192-5391
Mailing Address - Country:US
Mailing Address - Phone:908-301-5900
Mailing Address - Fax:908-301-5934
Practice Address - Street 1:150 NEW PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2590
Practice Address - Country:US
Practice Address - Phone:908-233-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22249L282E00000X
NJ28RS004173003336I0012X
3336L0003X
NJ22248L282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4439902Medicaid
NJ4505204Medicaid
NJ0806757Medicaid
3119319OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ0828424Medicaid
NJ4505221Medicaid