Provider Demographics
NPI:1316945561
Name:SAINT BARNABAS OUTPATIENT CENTERS
Entity type:Organization
Organization Name:SAINT BARNABAS OUTPATIENT CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AVP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-322-7331
Mailing Address - Street 1:1050 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7983
Mailing Address - Country:US
Mailing Address - Phone:908-206-2230
Mailing Address - Fax:908-206-2237
Practice Address - Street 1:200 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-322-7500
Practice Address - Fax:973-322-7501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT BARNABAS OUTPATIENT CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-12
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ70786261QH0700X, 261QM2500X, 261QP2000X, 261QX0100X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8751005Medicaid
NJ8755701Medicaid
NJ8755701Medicaid