Basic Information
| Provider Information | |||||||||
| NPI: | 1679680243 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERIDIAN HOSPITALS CORPORATION, INC. DBA JERSEY SHORE UNIVERSITY MEDIC | ||||||||
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| OtherOrganizationName: | JERSEY SHORE UNIVERSITY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 JUMPING BROOK RD | ||||||||
| Address2: | BLDG 5, STE 201, ATTN: BEHAVIORAL HEALTH CREDENTIALING | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326434372 | ||||||||
| FaxNumber: | 7326434376 | ||||||||
| Practice Location | |||||||||
| Address1: | 1945 ROUTE 33 | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326434363 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 05/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | PALERMO | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 7327513342 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.