Healthcare Provider Details

I. General information

NPI: 1013372457
Provider Name (Legal Business Name): SEWELL SENIOR CITIZEN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 HURSTVILLE CROSS KEYS RD SUITE A&B
SEWELL NJ
08080
US

IV. Provider business mailing address

2 RALEIGH WAY
FREEHOLD NJ
07728-7906
US

V. Phone/Fax

Practice location:
  • Phone: 732-284-6020
  • Fax: 267-878-0160
Mailing address:
  • Phone: 732-284-6020
  • Fax: 267-878-0160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateNJ

VIII. Authorized Official

Name: ASHISH DESAI
Title or Position: MEMBER
Credential:
Phone: 732-284-6020