MEDICARE: 2ND HOME UNION CITY LLC

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
1	313M00000X	Nursing Facility/Intermediate Care Facility	408111	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1962546648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	2ND HOME UNION CITY LLC

Provider Business Mailing Address
First Line	:	100 HAMILTON PLZ
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07505-2109
Country	:	US
Telephone Number	:	973-278-7065
Fax Number	:	973-278-4773

Provider Business Practice Location Address
First Line	:	3610 PALISADE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4718
Country	:	US
Telephone Number	:	201-864-0400
Fax Number	:	973-278-7065

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DAVID M MYERS
Credential	:	M.D.
Telephone Number	:	973-278-7065

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	08/22/2020

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Directions to “2ND HOME UNION CITY LLC ” Practice Location

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