Healthcare Provider Details

I. General information

NPI: 1659720381
Provider Name (Legal Business Name): NUTLEY ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357-361 HARRISON ST, 1ST FLOOR
NUTLEY NJ
07110
US

IV. Provider business mailing address

357-361 HARRISON ST, 1ST FLOOR
NUTLEY NJ
07110
US

V. Phone/Fax

Practice location:
  • Phone: 551-689-6100
  • Fax: 201-464-0245
Mailing address:
  • Phone: 551-689-6100
  • Fax: 201-464-0245

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: SAQIB J MALIK
Title or Position: DIRECTOR INFORMATION TECHNOLOGY
Credential:
Phone: 551-689-6100