Healthcare Provider Details

I. General information

NPI: 1447505524
Provider Name (Legal Business Name): HOTEL TRADES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 COLUMBUS DR
BAYONNE NJ
07002-4362
US

IV. Provider business mailing address

10 COLUMBUS DR
BAYONNE NJ
07002-4362
US

V. Phone/Fax

Practice location:
  • Phone: 201-436-3164
  • Fax:
Mailing address:
  • Phone: 201-436-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number481196-1
License Number StateNY

VIII. Authorized Official

Name: MRS. MARY THERESA CINTORINO
Title or Position: STAFF NURSE
Credential: RN
Phone: 201-914-2016