Basic Information
| Provider Information | |||||||||
| NPI: | 1609045277 | ||||||||
| 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: | 9739725960 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 BERGEN STREET | ||||||||
| Address2: | DEPARTMENT OF ANESTHESIOLOGY | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739727867 | ||||||||
| FaxNumber: | 9739722357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2008 | ||||||||
| LastUpdateDate: | 12/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | HAMSTRA | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERIM PRES./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 | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.