MEDICARE: TEAM MANAGEMENT 2000 INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	2000054-08	NJ
2	251S00000X	Community/Behavioral Health Agency	2000054-08	NJ

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1033356019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAM MANAGEMENT 2000 INC

Provider Business Mailing Address
First Line	:	20 BANTA PL
Second Line	:	SUITE 100
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-5611
Country	:	US
Telephone Number	:	201-487-4700
Fax Number	:	201-487-4787

Provider Business Practice Location Address
First Line	:	395 PLEASANT VALLEY WAY
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2998
Country	:	US
Telephone Number	:	973-326-2220
Fax Number	:	973-239-2666

Authorized Official
Title or Position	:	EXECUTIVE DIR/CEO
Name	:	AVA FAUSTIN
Credential	:
Telephone Number	:	201-487-4700

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/14/2009

3 SAINT STEPHENS PL , SUITE 2
WARWICK, NY
10990-3208

Practice Phone: 845-987-9700
Practice Fax:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

395 PLEASANT VALLEY WAY , THE PEDIATRIC GROUP OF WEST ORANGE
WEST ORANGE, NJ
07052-2998