MEDICARE: BAYTUL- IMAN, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1376953851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYTUL- IMAN, INC

Provider Business Mailing Address
First Line	:	428 MORRISTOWN RD
Second Line	:
City	:	MATAWAN
State	:	NJ
Zip	:	07747-3586
Country	:	US
Telephone Number	:	732-207-5893
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 LAUREL AVE
Second Line	:
City	:	HAZLET TOWNSHIP
State	:	NJ
Zip	:	07734-3023
Country	:	US
Telephone Number	:	732-207-5893
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR BUSINESS DEVELOPMENT
Name	:	MR. WAHID SHIBLI
Credential	:
Telephone Number	:	732-207-5893

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	05/05/2014

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