Healthcare Provider Details

I. General information

NPI: 1952743692
Provider Name (Legal Business Name): JEWISH COMMUNITY CENTER ON THE PALISADES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 EAST CLINTON AVENUE KAPLEN JCC ON THE PALISADES
TENAFLY NJ
07670
US

IV. Provider business mailing address

411 EAST CLINTON AVENUE
TENAFLY NJ
07670
US

V. Phone/Fax

Practice location:
  • Phone: 201-408-1489
  • Fax: 201-569-7448
Mailing address:
  • Phone: 201-408-1489
  • Fax: 201-569-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY LEVY
Title or Position: DIRECTOR, SPECIAL SERVICES
Credential:
Phone: 201-408-1489