=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093911042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEWISH COMMUNITY CENTER ON THE PALISADES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 E CLINTON AVE
-----------------------------------------------------
City | TENAFLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07670-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-569-7900
-----------------------------------------------------
Fax | 201-569-7448
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 E CLINTON AVE
-----------------------------------------------------
City | TENAFLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07670-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-569-7900
-----------------------------------------------------
Fax | 201-569-7448
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, KAPLEN ADULT REACH CENTER
-----------------------------------------------------
Name | MRS. VIVIAN KORNER
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 201-569-7900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------