Provider Demographics
NPI:1538531157
Name:RUTGERS, THE STATE UNIVERSITY
Entity type:Organization
Organization Name:RUTGERS, THE STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELODEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:848-932-7402
Mailing Address - Street 1:PO BOX 18999
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07191-8999
Mailing Address - Country:US
Mailing Address - Phone:848-932-9056
Mailing Address - Fax:732-932-1525
Practice Address - Street 1:11 BISHOP PL
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1178
Practice Address - Country:US
Practice Address - Phone:848-932-9056
Practice Address - Fax:732-932-1525
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTGERS, THE STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-22
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty