Healthcare Provider Details

I. General information

NPI: 1780710202
Provider Name (Legal Business Name): AMBASSADOR MEDICAL DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 RIVER AVENUE
LAKEWOOD NJ
08701
US

IV. Provider business mailing address

643 CROSS ST
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-1133
  • Fax: 732-370-1087
Mailing address:
  • Phone: 732-730-9280
  • Fax: 732-730-8407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number080187
License Number StateNJ

VIII. Authorized Official

Name: AARON STEFANSY
Title or Position: CONTROLLER
Credential:
Phone: 732-730-9280