Provider Demographics
NPI:1699775460
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:CHIEF FINANCIAL CENTER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIBNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-322-7286
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:973-322-7430
Practice Address - Fax:973-322-7460
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT BARNABAS OUTPATIENT CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-22
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RE0101X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8040401Medicaid
NJ8040401Medicaid