Provider Demographics
NPI:1548506686
Name:RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
Entity type:Organization
Organization Name:RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, STUDENT HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-353-5232
Mailing Address - Street 1:249 UNIVERSITY AVE
Mailing Address - Street 2:BLUMENTHAL HALL, ROOM 104
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1808
Mailing Address - Country:US
Mailing Address - Phone:973-353-5232
Mailing Address - Fax:
Practice Address - Street 1:249 UNIVERSITY AVE
Practice Address - Street 2:BLUMENTHAL HALL, ROOM 104
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1808
Practice Address - Country:US
Practice Address - Phone:973-353-5232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health