Provider Demographics
NPI:1881958775
Name:UMDNJ
Entity type:Organization
Organization Name:UMDNJ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCE PRACTICE NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANDRIKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEYAMOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:APN-C
Authorized Official - Phone:732-235-9645
Mailing Address - Street 1:195 LITTLE ALBANY ST
Mailing Address - Street 2:ROOM 1124
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1914
Mailing Address - Country:US
Mailing Address - Phone:732-235-9645
Mailing Address - Fax:732-235-3299
Practice Address - Street 1:195 LITTLE ALBANY ST
Practice Address - Street 2:ROOM 1124
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1914
Practice Address - Country:US
Practice Address - Phone:732-235-9645
Practice Address - Fax:732-235-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00291400282N00000X, 261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No282N00000XHospitalsGeneral Acute Care Hospital