Provider Demographics
NPI:1992118137
Name:ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL
Entity type:Organization
Organization Name:ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VP FINANCE & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-418-8346
Mailing Address - Street 1:110 REHILL AVE
Mailing Address - Street 2:ADMINISTRATIVE OFFICE, ATTENTION: CFO
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2519
Mailing Address - Country:US
Mailing Address - Phone:732-937-8537
Mailing Address - Fax:732-937-8941
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:ATTENTION: SOMERSET FAMILY PRACTICE
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-685-2900
Practice Address - Fax:908-704-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ310048Medicare Oscar/Certification