Provider Demographics
NPI:1679943088
Name:GREENVILLE MEDICAL CENTER LLC
Entity type:Organization
Organization Name:GREENVILLE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:201-547-3550
Mailing Address - Street 1:450 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-3274
Mailing Address - Country:US
Mailing Address - Phone:201-547-3550
Mailing Address - Fax:
Practice Address - Street 1:450 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-3274
Practice Address - Country:US
Practice Address - Phone:201-547-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00436100164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00523500Medicare Oscar/Certification