Provider Demographics
NPI:1912308925
Name:TRINITAS REGIONAL MEDICAL CENTER - SLEEP DISORDER CENTER
Entity type:Organization
Organization Name:TRINITAS REGIONAL MEDICAL CENTER - SLEEP DISORDER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-994-5457
Mailing Address - Street 1:225 WILLIAMSON STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07207
Mailing Address - Country:US
Mailing Address - Phone:908-994-5000
Mailing Address - Fax:908-994-8121
Practice Address - Street 1:225 WILLIAMSON STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07207
Practice Address - Country:US
Practice Address - Phone:908-994-5049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITAS REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1174207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty