Healthcare Provider Details

I. General information

NPI: 1750403473
Provider Name (Legal Business Name): BROADWAT ADULT MEDICAL DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 BROADWAY
NEWARK NJ
07104-3401
US

IV. Provider business mailing address

717 BROADWAY # 727
NEWARK NJ
07104-3401
US

V. Phone/Fax

Practice location:
  • Phone: 973-268-1212
  • Fax: 973-268-1016
Mailing address:
  • Phone: 973-268-1212
  • Fax: 973-268-1016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number308116
License Number StateNJ

VIII. Authorized Official

Name: MRS. ZOYA HALAL
Title or Position: OWNER
Credential:
Phone: 973-268-1212