Healthcare Provider Details

I. General information

NPI: 1689998809
Provider Name (Legal Business Name): MADISON HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 W LAUREL RD
STRATFORD NJ
08084-1718
US

IV. Provider business mailing address

18 W LAUREL RD
STRATFORD NJ
08084-1718
US

V. Phone/Fax

Practice location:
  • Phone: 856-784-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number060405
License Number StateNJ

VIII. Authorized Official

Name: MOSHE BRODT
Title or Position: MANAGER
Credential:
Phone: 856-784-2400