Provider Demographics
NPI:1801966023
Name:RUTGERS, THE STATE UNIV
Entity type:Organization
Organization Name:RUTGERS, THE STATE UNIV
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TAX DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARABEDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPR MS-TRX
Authorized Official - Phone:732-445-2054
Mailing Address - Street 1:65 DAVIDSON RD
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854
Mailing Address - Country:US
Mailing Address - Phone:732-445-2054
Mailing Address - Fax:732-445-5922
Practice Address - Street 1:11 BISHOP PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1178
Practice Address - Country:US
Practice Address - Phone:732-932-8033
Practice Address - Fax:732-932-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2008-08-06
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-08-05
Provider Licenses
StateLicense IDTaxonomies
NJ28RS002347003336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3121162OtherNCPDP