Healthcare Provider Details

I. General information

NPI: 1982357729
Provider Name (Legal Business Name): PRESTIGE OF EWING AMDC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 N OLDEN AVE
EWING NJ
08638-3210
US

IV. Provider business mailing address

53 HADDONFIELD RD STE 312
CHERRY HILL NJ
08002-4802
US

V. Phone/Fax

Practice location:
  • Phone: 609-434-0041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ISAAC FELSENBURG
Title or Position: MEMBER
Credential:
Phone: 917-951-3150