Healthcare Provider Details

I. General information

NPI: 1972295285
Provider Name (Legal Business Name): MONARCH PLAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MIDTOWN CIR
LAKEWOOD NJ
08701-7604
US

IV. Provider business mailing address

1 MIDTOWN CIR
LAKEWOOD NJ
08701-7604
US

V. Phone/Fax

Practice location:
  • Phone: 201-423-5308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIRIAM GOLDIE WEISS
Title or Position: REGISTERED AGENT
Credential:
Phone: 732-994-7566