Healthcare Provider Details

I. General information

NPI: 1063349959
Provider Name (Legal Business Name): PEACEFUL POTATO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 MANOR CT
LYNDHURST NJ
07071-1007
US

IV. Provider business mailing address

343 MANOR CT
LYNDHURST NJ
07071-1007
US

V. Phone/Fax

Practice location:
  • Phone: 201-575-0291
  • Fax:
Mailing address:
  • Phone: 201-575-0291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN JIOSI
Title or Position: OWNER
Credential:
Phone: 201-575-0291