Basic Information
Provider Information | |||||||||
NPI: | 1306105580 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MERIDIAN HOSPITLALS COOPERATION DBA JSUMC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 17 HOMESTEAD RD | ||||||||
Address2: |   | ||||||||
City: | SEA GIRT | ||||||||
State: | NJ | ||||||||
PostalCode: | 087501938 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7324497809 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1945 HWY 33 | ||||||||
Address2: |   | ||||||||
City: | NEPTUNE | ||||||||
State: | NJ | ||||||||
PostalCode: | 077534859 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7327762325 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/09/2012 | ||||||||
LastUpdateDate: | 05/09/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | COLEMAN | ||||||||
AuthorizedOfficialFirstName: | WINIFRED | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | NURSE MANAGER ASSISTANT | ||||||||
AuthorizedOfficialTelephone: | 7327762325 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | RN | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 26NR06016600 | NJ | Y |   | Hospitals | General Acute Care Hospital |   |
No ID Information.