Healthcare Provider Details

I. General information

NPI: 1013945609
Provider Name (Legal Business Name): JERSEY HEALTHCARE RESOURCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S NEWMAN ST
HACKENSACK NJ
07601-3211
US

IV. Provider business mailing address

55 S NEWMAN ST
HACKENSACK NJ
07601-3211
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-9000
  • Fax: 201-489-9000
Mailing address:
  • Phone: 201-489-9000
  • Fax: 201-489-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier7867603
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. RICHARD PINELES
Title or Position: PRESIDENT
Credential:
Phone: 201-489-7400