Basic Information
| Provider Information | |||||||||
| NPI: | 1114179025 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLARA MAASS MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 CLARA MAASS DRIVE | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071093550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734502000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 CLARA MAASS DR | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071093550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734502000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2008 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| AuthorizedOfficialLastName: | CLYNE | ||||||||
| AuthorizedOfficialFirstName: | MARY ELLEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9734502002 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BARNABAS HEALTH INC | ||||||||
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| AuthorizedOfficialCredential: | PH.D | ||||||||
| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 10701 | NJ | N | Hospital Units | Psychiatric Unit | 273R00000X | NJ | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 4135504 | 05 | NJ | MEDICAID |