Healthcare Provider Details

I. General information

NPI: 1063681179
Provider Name (Legal Business Name): SECOND INNING1 ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 ALGONQUIN PKWY
WHIPPANY NJ
07981-1601
US

IV. Provider business mailing address

155 ALGONQUIN PKWY
WHIPPANY NJ
07981-1601
US

V. Phone/Fax

Practice location:
  • Phone: 190-832-9555
  • Fax: 173-263-5209
Mailing address:
  • Phone: 190-832-9555
  • Fax: 173-263-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberIN PROCESS
License Number StateNJ

VIII. Authorized Official

Name: MR. JAGAT MEHTA
Title or Position: OWNER
Credential:
Phone: 190-832-9555