Healthcare Provider Details

I. General information

NPI: 1760854905
Provider Name (Legal Business Name): AMBASSADOR HATZLACHA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 RIVER AVE
LAKEWOOD NJ
08701-5227
US

IV. Provider business mailing address

619 RIVER AVE
LAKEWOOD NJ
08701-5227
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-1133
  • Fax:
Mailing address:
  • Phone: 732-367-1133
  • 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: LEAH RIEDER
Title or Position: OWNER
Credential:
Phone: 732-616-0771