Basic Information
| Provider Information | |||||||||
| NPI: | 1992118137 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL | ||||||||
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| OtherOrganizationName: | ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL SOMERSET | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 REHILL AVE | ||||||||
| Address2: | ADMINISTRATIVE OFFICE, ATTENTION: CFO | ||||||||
| City: | SOMERVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088762519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7329378537 | ||||||||
| FaxNumber: | 7329378941 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 REHILL AVE | ||||||||
| Address2: | ATTENTION: SOMERSET FAMILY PRACTICE | ||||||||
| City: | SOMERVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088762519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086852900 | ||||||||
| FaxNumber: | 9087040083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2014 | ||||||||
| LastUpdateDate: | 06/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | REILLY | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VP FINANCE & CFO | ||||||||
| AuthorizedOfficialTelephone: | 7324188346 | ||||||||
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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 | 207Q00000X | 11802 | NJ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.