Healthcare Provider Details

I. General information

NPI: 1669697280
Provider Name (Legal Business Name): ELDERCARE OF ELIZABETH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N BROAD ST
ELIZABETH NJ
07208-3302
US

IV. Provider business mailing address

550 N BROAD ST
ELIZABETH NJ
07208-3302
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-0050
  • Fax: 908-994-0056
Mailing address:
  • Phone: 908-994-0050
  • Fax: 908-994-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number908116
License Number StateNJ

VIII. Authorized Official

Name: MR. HAROLD C. HERSKOWITZ
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 908-994-0050