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General NPI Number Information
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NPI Number | 1750403473
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Entity Type | Organization
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Legal Business Name | BROADWAT ADULT MEDICAL DAY CARE CENTER
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 717 BROADWAY
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City | NEWARK
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State | NJ
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Zip | 07104-3401
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Country | US
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Telephone | 973-268-1212
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Fax | 973-268-1016
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Provider Business Mailing Address
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Address Line | 717 BROADWAY # 727
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City | NEWARK
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State | NJ
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Zip | 07104-3401
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Country | US
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Telephone | 973-268-1212
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Fax | 973-268-1016
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ZOYA HALAL
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Credential |
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Telephone | 973-268-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 308116
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License Number State | NJ
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