Provider Demographics
NPI:1700968187
Name:RUTGERS HEALTH-RWJ SCLERODERMA PROGRAM
Entity Type:Organization
Organization Name:RUTGERS HEALTH-RWJ SCLERODERMA PROGRAM
Other - Org Name:RUTGERS HEALTH-RWJ PSYCHOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-235-6070
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:RED BAML
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:671 HOES LN
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-5627
Practice Address - Country:US
Practice Address - Phone:732-235-4402
Practice Address - Fax:732-235-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3456200Medicaid
NJ3456200Medicaid