Healthcare Provider Details

I. General information

NPI: 1992045405
Provider Name (Legal Business Name): JAY SHREE KRISHNA MOONACHIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E PARK ST
MOONACHIE NJ
07074-1138
US

IV. Provider business mailing address

311 E PARK ST
MOONACHIE NJ
07074-1138
US

V. Phone/Fax

Practice location:
  • Phone: 973-202-5072
  • Fax: 973-882-3162
Mailing address:
  • Phone: 973-202-5072
  • Fax: 973-882-3162

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. PARUL V SHAH
Title or Position: MEMBER
Credential: MANAGEMENT
Phone: 973-202-5072