MEDICARE: PERSON FIRST, NEW JERSEY, 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	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

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

General Provider Information

NPI Number	:	1477011021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSON FIRST, NEW JERSEY, LLC

Provider Business Mailing Address
First Line	:	14 HEGGAN LN
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037-9502
Country	:	US
Telephone Number	:	609-249-6151
Fax Number	:	609-651-4376

Provider Business Practice Location Address
First Line	:	858 S WHITE HORSE PIKE STE B1
Second Line	:
City	:	HAMMONTON
State	:	NJ
Zip	:	08037-2031
Country	:	US
Telephone Number	:	609-481-2729
Fax Number	:	609-651-4376

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	FRANCIS NKAM
Credential	:
Telephone Number	:	609-481-2729

Provider Enumeration Date	:	03/03/2019
Last Update Date	:	03/03/2020

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