Provider Demographics
NPI:1669737755
Name:RUTGERS NURSING FACULTY PRACTICE
Entity type:Organization
Organization Name:RUTGERS NURSING FACULTY PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,MS,RN
Authorized Official - Phone:973-972-5141
Mailing Address - Street 1:274 S ORANGE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2419
Mailing Address - Country:US
Mailing Address - Phone:973-732-6040
Mailing Address - Fax:862-902-7874
Practice Address - Street 1:274 S ORANGE AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2419
Practice Address - Country:US
Practice Address - Phone:973-732-6040
Practice Address - Fax:862-902-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0742791Medicaid
NJ0497436Medicaid
NJ0486434Medicaid