Healthcare Provider Details

I. General information

NPI: 1699709261
Provider Name (Legal Business Name): MR OF PARKVIEW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 5TH AVE
CARNEYS POINT NJ
08069-1059
US

IV. Provider business mailing address

1 UNIVERSITY PLZ SUITE 206
HACKENSACK NJ
07601-6201
US

V. Phone/Fax

Practice location:
  • Phone: 856-299-6800
  • Fax: 856-299-7791
Mailing address:
  • Phone: 201-488-6789
  • Fax: 201-488-7734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number061702
License Number StateNJ

VIII. Authorized Official

Name: FISCHEL RISPLER
Title or Position: MEMBER
Credential:
Phone: 201-488-6789