Healthcare Provider Details

I. General information

NPI: 1780858191
Provider Name (Legal Business Name): NURSE PRACTITIONERS IN LONG TERM CARE LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1992 MORRIS AVE SUITE 214
UNION NJ
07083-3507
US

IV. Provider business mailing address

1992 MORRIS AVE SUITE 214
UNION NJ
07083-3507
US

V. Phone/Fax

Practice location:
  • Phone: 973-843-2099
  • Fax:
Mailing address:
  • Phone: 973-843-2099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NR07760600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332171
License Number StateNJ

VIII. Authorized Official

Name: MS. MAXINE MCGOWAN
Title or Position: OWNER
Credential: NP
Phone: 973-843-2099