NPIMap

Organization Active NPI

Jewish Renaissance Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Newark, NJ
National Provider Identifier
1225240971
Registry record updated Oct 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
23981 Issued in NJ
Legal business name
JEWISH RENAISSANCE MEDICAL CENTER, INC.
Practice address
226 Dayton St
Newark, NJ 07114-1159
Phone
(973) 733-8781
NPI assigned
May 4, 2007
Last updated
Oct 20, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Roberts
Title
Ceo
Phone
(732) 376-6601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 23981 NJ Primary

Addresses

Primary practice location

226 Dayton St
Newark, NJ 07114-1159

Mailing address

PO Box 1220
Perth Amboy, NJ 08862-1220
Phone (732) 376-6635

Other identifiers 5

IdentifierTypeStateIssuer
0097845MedicaidNJ
8462500MedicaidNJ
8932603MedicaidNJ
0115045MedicaidNJ
0751103MedicaidNJ

National Provider Directory

National Provider Directory
Tax ID family
Central Jersey Medical Center Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

226 Dayton St
Newark, NJ 07114
Phone (973) 679-7709

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255996800000",
    "number": "1225240971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1220",
            "city": "PERTH AMBOY",
            "state": "NJ",
            "postal_code": "088621220",
            "telephone_number": "732-376-6635",
            "fax_number": "732-324-5765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 DAYTON ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071141159",
            "telephone_number": "973-733-8781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWISH RENAISSANCE MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2009-10-20",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "732-376-6601"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NJ",
            "license": "23981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0097845",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8462500",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8932603",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0115045",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0751103",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.