Healthcare Provider Details

I. General information

NPI: 1023657475
Provider Name (Legal Business Name): NORTH JERSEY PEDIATRIC AND ADULT NURSING AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 RINGWOOD AVE
HASKELL NJ
07420-1520
US

IV. Provider business mailing address

1433 RINGWOOD AVE
HASKELL NJ
07420-1520
US

V. Phone/Fax

Practice location:
  • Phone: 732-328-6610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ABRAHAM KRAUS
Title or Position: CEO
Credential:
Phone: 732-328-6610