Healthcare Provider Details

I. General information

NPI: 1477646636
Provider Name (Legal Business Name): MIDDLESEX COUNTY IMPROVEMENT AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/08/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 PARSONAGE RD
EDISON NJ
08837-2424
US

IV. Provider business mailing address

118 PARSONAGE RD
EDISON NJ
08837-2424
US

V. Phone/Fax

Practice location:
  • Phone: 732-321-6800
  • Fax: 732-321-0734
Mailing address:
  • Phone: 732-321-6800
  • Fax: 732-321-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number021203
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4485416
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer
# 2
Identifier4485408
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MARK SORRENTO
Title or Position: ADMINISTRATOR
Credential:
Phone: 732-767-3720