| Jewish Renaissance Medical Center, Inc. | |
|
90 Parker St Newark NJ 07104-1028 | |
| (973) 497-5773 | |
| Not Available |
| Full Name | Jewish Renaissance Medical Center, Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 90 Parker St, Newark, New Jersey |
| Authorized Official Name and Position | Mark Roberts (CEO) |
| Authorized Official Contact | 7323766601 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jewish Renaissance Medical Center, Inc. Po Box 1220 Perth Amboy NJ 08862-1220 Ph: (732) 376-6601 | Jewish Renaissance Medical Center, Inc. 90 Parker St Newark NJ 07104-1028 Ph: (973) 497-5773 |
| NPI Number | 1811109572 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 10/20/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811109572 | NPI | - | NPPES |
| 0751103 | Medicaid | NJ | |
| 0115045 | Medicaid | NJ | |
| 0097811 | Medicaid | NJ | |
| 8462500 | Medicaid | NJ | |
| 8932603 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 23973 (New Jersey) | Primary |
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