MEDICARE: ENGEL BURMAN AT WAYNE, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1710524087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENGEL BURMAN AT WAYNE, LLC

Provider Business Mailing Address
First Line	:	1440 HAMBURG TURNPIKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470
Country	:	US
Telephone Number	:	973-987-3600
Fax Number	:	973-987-3601

Provider Business Practice Location Address
First Line	:	1440 HAMBURG TURNPIKE
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470
Country	:	US
Telephone Number	:	973-987-3600
Fax Number	:	973-987-3601

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. STEVEN KRIEGER
Credential	:
Telephone Number	:	516-747-1200

Provider Enumeration Date	:	12/05/2019
Last Update Date	:	12/05/2019

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