Healthcare Provider Details

I. General information

NPI: 1831993013
Provider Name (Legal Business Name): PASSAIC RIVER ROWING ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/04/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 RIVERSIDE AVENUE
LYNDHURST NJ
07071
US

IV. Provider business mailing address

797 RIVERSIDE AVENUE
LYNDHURST NJ
07071
US

V. Phone/Fax

Practice location:
  • Phone: 201-283-2069
  • Fax:
Mailing address:
  • Phone: 201-283-2069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSE ANTUNES
Title or Position: TREASURER
Credential:
Phone: 201-283-2069