Basic Information
| Provider Information | |||||||||
| NPI: | 1306053483 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 133 HARDWOOD DR | ||||||||
| Address2: | |||||||||
| City: | TAPPAN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109831121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739725108 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 BERGEN ST # D106 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739725108 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OBRIEN | ||||||||
| AuthorizedOfficialFirstName: | ALICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADVANCED PRACTICE NURSE | ||||||||
| AuthorizedOfficialTelephone: | 9739725108 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CLINICAL SPECIALIST | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 26NR05111400 | NJ | Y | Hospitals | General Acute Care Hospital |
No ID Information.