MEDICARE: TUCKERTON OPERATING, LLC

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1457246555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TUCKERTON OPERATING, LLC

Provider Business Mailing Address
First Line	:	460 BAYVIEW AVE
Second Line	:
City	:	INWOOD
State	:	NY
Zip	:	11096-1702
Country	:	US
Telephone Number	:	718-360-8083
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 TUCKERTON RD
Second Line	:
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8803
Country	:	US
Telephone Number	:	856-983-8500
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	CHARLES-EDOUARD GROS
Credential	:
Telephone Number	:	718-360-8083

Provider Enumeration Date	:	06/10/2025
Last Update Date	:	06/10/2025

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Directions to “TUCKERTON OPERATING, LLC ” Practice Location

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