Healthcare Provider Details

I. General information

NPI: 1831798305
Provider Name (Legal Business Name): SOUTH BRUNSWICK ADC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2020
Last Update Date: 10/25/2020
Certification Date: 10/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CORNWALL RD STE 500
MONMOUTH JUNCTION NJ
08852-2444
US

IV. Provider business mailing address

2000 CORNWALL RD STE 500
MONMOUTH JUNCTION NJ
08852-2444
US

V. Phone/Fax

Practice location:
  • Phone: 732-673-5679
  • Fax:
Mailing address:
  • Phone: 732-673-5679
  • 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: MRS. VANDANA NAYAK
Title or Position: ASST. ADMIN
Credential: ASST. ADMIN
Phone: 732-673-5679