Basic Information
| Provider Information | |||||||||
| NPI: | 1023266962 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 BERGEN STREET, | ||||||||
| Address2: | ADMC 1327 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071011709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739720882 | ||||||||
| FaxNumber: | 9739729129 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 BERGEN STREET | ||||||||
| Address2: | DEPTPARTMENT OF EMERGENCY ROOM M-219 | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071011709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739721193 | ||||||||
| FaxNumber: | 9739726646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2008 | ||||||||
| LastUpdateDate: | 07/16/2015 | ||||||||
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| AuthorizedOfficialLastName: | HAMSTRA | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERIM PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9739724752 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.