Basic Information
| Provider Information | |||||||||
| NPI: | 1659387975 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HOSPITAL GROUP INC | ||||||||
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| OtherOrganizationName: | JFK UNIVERSITY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 JAMES ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088203938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323217891 | ||||||||
| FaxNumber: | 7326321676 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 JAMES ST | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088203947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323217000 | ||||||||
| FaxNumber: | 7326321676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT, CFO | ||||||||
| AuthorizedOfficialTelephone: | 7323217747 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 11201 | NJ | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 3676803 | 05 | NJ | MEDICAID |