Provider Demographics
NPI:1679880983
Name:RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY
Entity type:Organization
Organization Name:RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, HEALTH SVC
Authorized Official - Prefix:
Authorized Official - First Name:MELODEE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-932-7402
Mailing Address - Street 1:PO BOX 168007
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75016-8007
Mailing Address - Country:US
Mailing Address - Phone:866-890-6390
Mailing Address - Fax:469-735-4640
Practice Address - Street 1:17 SENIOR ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-8534
Practice Address - Country:US
Practice Address - Phone:732-932-7884
Practice Address - Fax:732-932-8278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUTGERS, THAT STATE UNIVERSITY OF NEW JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty