Provider Demographics
NPI:1205168192
Name:JERSEY CITY MEDICAL CENTER
Entity type:Organization
Organization Name:JERSEY CITY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-521-5920
Mailing Address - Street 1:355 GRAND ST
Mailing Address - Street 2:EXECUTIVE SUITE
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4321
Mailing Address - Country:US
Mailing Address - Phone:201-915-2000
Mailing Address - Fax:201-770-3750
Practice Address - Street 1:115 CHRISTOPHER COLUMBUS DR
Practice Address - Street 2:DEPARTMENT OF DENTISTRY
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5526
Practice Address - Country:US
Practice Address - Phone:201-369-3228
Practice Address - Fax:201-770-3750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERSEY CITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-03
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10904261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ310074Medicare PIN