Healthcare Provider Details

I. General information

NPI: 1376385435
Provider Name (Legal Business Name): NJ HEALTHCARE SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 BOULEVARD STE 2
HASBROUCK HEIGHTS NJ
07604-1844
US

IV. Provider business mailing address

174 BOULEVARD STE 2
HASBROUCK HEIGHTS NJ
07604-1844
US

V. Phone/Fax

Practice location:
  • Phone: 201-426-0299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. POORNIMA SHIVKUMAR
Title or Position: PRESIDENT
Credential:
Phone: 201-426-0299