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NPI Code Detail

MEDICARE: BRISTOL GLEN INC

MEDICARE: BRISTOL GLEN INC
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
1314000000XSkilled Nursing Facility314000000XNJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588740401
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRISTOL GLEN INC
Provider Business Mailing Address
First Line : 205 JUMPING BROOK RD
Second Line :
City : NEPTUNE
State : NJ
Zip : 07753-3197
Country : US
Telephone Number : 732-922-9800
Fax Number : 732-922-9804
Provider Business Practice Location Address
First Line : 200 BRISTOL GLEN DR
Second Line :
City : NEWTON
State : NJ
Zip : 07860-2329
Country : US
Telephone Number : 973-300-5788
Fax Number : 973-579-2357
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : ROBERT PETERSON
Credential :
Telephone Number : 732-922-9800
Provider Enumeration Date : 10/31/2006
Last Update Date : 10/30/2023

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Directions to “BRISTOL GLEN INC ” Practice Location

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