MEDICARE: ROBERT WOOD JOHNSON VISITING NURSES, 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	251G00000X	Community Based Hospice Care Agency	22594	NJ

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
2	22594	OTHER	NJ	HOSPICE LICENSE

General Provider Information

NPI Number	:	1700968609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT WOOD JOHNSON VISITING NURSES, INC.

Provider Business Mailing Address
First Line	:	23 MAIN ST STE D1
Second Line	:
City	:	HOLMDEL
State	:	NJ
Zip	:	07733-2136
Country	:	US
Telephone Number	:	732-224-6914
Fax Number	:	732-784-9710

Provider Business Practice Location Address
First Line	:	972 SHOPPES BLVD
Second Line	:
City	:	NORTH BRUNSWICK
State	:	NJ
Zip	:	08902-2776
Country	:	US
Telephone Number	:	732-743-4643
Fax Number	:	732-743-4659

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	PETER GAYLORD
Credential	:
Telephone Number	:	732-224-6968

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	10/05/2018

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