Provider Demographics
NPI:1952342990
Name:UNDERWOOD-MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:UNDERWOOD-MEMORIAL HOSPITAL
Other - Org Name:UMH FAMILY HEALTH CENTER OF WOOLWICH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC.VP/ COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-845-0100
Mailing Address - Street 1:1120 DELSEA DR N
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1444
Mailing Address - Country:US
Mailing Address - Phone:856-686-5480
Mailing Address - Fax:856-686-5455
Practice Address - Street 1:100 LEXINGTON RD
Practice Address - Street 2:BLDG 1
Practice Address - City:WOOLWICH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1276
Practice Address - Country:US
Practice Address - Phone:856-467-7360
Practice Address - Fax:856-467-5959
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNDERWOOD-MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-09
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJFACILITY10801207Q00000X
207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123771Medicare PIN