Healthcare Provider Details

I. General information

NPI: 1316645476
Provider Name (Legal Business Name): AGE OF PLAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 HIGHPOINT RD
HOLMDEL NJ
07733-1605
US

IV. Provider business mailing address

7 HIGHPOINT RD
HOLMDEL NJ
07733-1605
US

V. Phone/Fax

Practice location:
  • Phone: 917-838-7267
  • Fax:
Mailing address:
  • Phone: 917-838-7267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TATYANA CHERTOK
Title or Position: OWNER
Credential:
Phone: 917-838-7267