=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215072657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESSEX MEDICAL DAY CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 263 HILLSIDE AVE
-----------------------------------------------------
City | NUTLEY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07110-1180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-662-9191
-----------------------------------------------------
Fax | 973-662-1112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 263 HILLSIDE AVENUE
-----------------------------------------------------
City | NUTLEY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07110-1180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-662-9191
-----------------------------------------------------
Fax | 973-662-1112
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ALEX RUBIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-662-9191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 308120
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------