Provider Demographics
NPI:1982773263
Name:LIBERTY RIVERSIDE HEALTHCARE
Entity Type:Organization
Organization Name:LIBERTY RIVERSIDE HEALTHCARE
Other - Org Name:MEADOWLANDS HOSPITAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-521-5920
Mailing Address - Street 1:1 HARMON MEADOW BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3600
Mailing Address - Country:US
Mailing Address - Phone:201-770-3709
Mailing Address - Fax:201-770-3750
Practice Address - Street 1:55 MEADOWLANDS PKWY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2977
Practice Address - Country:US
Practice Address - Phone:201-770-3709
Practice Address - Fax:201-770-3750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY RIVERSIDE HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-08
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10906314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315498Medicare ID - Type Unspecified