MEDICARE: MEDFORD CONVALESCENT & NURSING CENTER

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	060313	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03140	OTHER	NJ	NJ
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467459008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDFORD CONVALESCENT & NURSING CENTER

Provider Business Mailing Address
First Line	:	185 TUCKERTON RD
Second Line	:
City	:	MEDFORD
State	:	NJ
Zip	:	08055-8803
Country	:	US
Telephone Number	:	856-983-8500
Fax Number	:	856-983-8965

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	:	856-983-8965

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICHARD PINELES
Credential	:
Telephone Number	:	201-489-7400

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	06/27/2008

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