Healthcare Provider Details

I. General information

NPI: 1154464931
Provider Name (Legal Business Name): EASTERN NURSING SERVICES I, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 UNION ST 2ND FLOOR
HACKENSACK NJ
07601-4203
US

IV. Provider business mailing address

286 UNION ST 2ND FLOOR
HACKENSACK NJ
07601-4203
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-6160
  • Fax: 201-881-0120
Mailing address:
  • Phone: 201-343-6160
  • Fax: 201-343-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0000216
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier8314004
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. CHARLES NUZZO
Title or Position: PRESIDENT
Credential:
Phone: 201-343-6160