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NPI Code Detail

MEDICARE: J&C PICACHE - IGWT

MEDICARE: J&C PICACHE - IGWT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251E00000XHome Health AgencyHP0122300NJ

General Provider Information

NPI Number : 1467688135
Entity Type Code : Organization
Provider Name (Legal Business Name) : J&C PICACHE - IGWT
Provider Business Mailing Address
First Line : 39 FOX HILL RD
Second Line :
City : UPPER SADDLE RIVER
State : NJ
Zip : 07458-1314
Country : US
Telephone Number : 201-962-3222
Fax Number : 201-962-3737
Provider Business Practice Location Address
First Line : 61 N WASHINGTON AVE
Second Line :
City : BERGENFIELD
State : NJ
Zip : 07621-1751
Country : US
Telephone Number : 201-962-3222
Fax Number : 201-962-3737
Authorized Official
Title or Position : MANAGING PARTNER
Name : MR. JONATHAN G PICACHE
Credential :
Telephone Number : 201-962-3222
Provider Enumeration Date : 06/08/2009
Last Update Date : 04/26/2016

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Directions to “J&C PICACHE - IGWT ” Practice Location

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