Healthcare Provider Details

I. General information

NPI: 1457406068
Provider Name (Legal Business Name): NEW JERSEY VETERANS MEMORIAL HOME AT PARAMUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS WAY
PARAMUS NJ
07652-4100
US

IV. Provider business mailing address

1 VETERANS WAY
PARAMUS NJ
07652-4100
US

V. Phone/Fax

Practice location:
  • Phone: 201-634-8510
  • Fax: 201-967-8658
Mailing address:
  • Phone: 201-634-8510
  • Fax: 201-967-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060228
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. GERARD FEENAN
Title or Position: BUSINESS MANAGER
Credential: MBA
Phone: 201-634-8509