Healthcare Provider Details

I. General information

NPI: 1699657684
Provider Name (Legal Business Name): PLATINUM HEARTS A NJ NON-PROFIT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 RARITAN AVE LOWR LEVEL
HIGHLAND PARK NJ
08904-2701
US

IV. Provider business mailing address

309 RARITAN AVE LOWR LEVEL
HIGHLAND PARK NJ
08904-2701
US

V. Phone/Fax

Practice location:
  • Phone: 732-658-3771
  • Fax: 732-658-3774
Mailing address:
  • Phone: 732-658-3771
  • Fax: 732-658-3774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHARON E BENJAMIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 201-697-9802