| Jewish Renaissance Medical Center At 13th Ave School | |
|
359 13th Ave Newark NJ 07103-2125 | |
| (973) 679-7709 | |
| (732) 324-5765 |
| Full Name | Jewish Renaissance Medical Center At 13th Ave School |
|---|---|
| Speciality | Clinic/Center |
| Location | 359 13th Ave, Newark, New Jersey |
| Authorized Official Name and Position | Jack O'leary (CEO) |
| Authorized Official Contact | 7323769333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jewish Renaissance Medical Center At 13th Ave School Po Box 1220 Attn: Credentialing/hr Perth Amboy NJ 08862 Ph: (732) 376-6635 | Jewish Renaissance Medical Center At 13th Ave School 359 13th Ave Newark NJ 07103-2125 Ph: (973) 679-7709 |
| NPI Number | 1982087607 |
|---|---|
| Provider Enumeration Date | 06/30/2015 |
| Last Update Date | 01/27/2023 |
| Medicare PECOS PAC ID | 1456301241 |
|---|---|
| Medicare Enrollment ID | O20150819008410 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982087607 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 22864 (New Jersey) | Primary |
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