Healthcare Provider Details

I. General information

NPI: 1669508032
Provider Name (Legal Business Name): 101 WHIPPANY ROAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WHIPPANY RD
WHIPPANY NJ
07981-1407
US

IV. Provider business mailing address

101 WHIPPANY RD
WHIPPANY NJ
07981-1407
US

V. Phone/Fax

Practice location:
  • Phone: 973-887-0311
  • Fax: 973-887-8355
Mailing address:
  • Phone: 973-887-0311
  • Fax: 973-887-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BRESLIN
Title or Position: EXECUTIVE VP
Credential:
Phone: 201-242-4004