Healthcare Provider Details

I. General information

NPI: 1952402737
Provider Name (Legal Business Name): AMEDISYS NEW JERSEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MAIN ST STE 252
HACKENSACK NJ
07601-7086
US

IV. Provider business mailing address

3854 AMERICAN WAY SUITE A
BATON ROUGE LA
70816-4013
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-6311
  • Fax: 201-678-9670
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number70202
License Number StateNJ

VII. Legacy identifiers

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

# 1
Identifier0261653
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerMEDICAID
# 2
Identifier0249114
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. PAUL B KUSSEROW
Title or Position: PRESIDENT
Credential:
Phone: 225-292-2031