MEDICARE: PUERTO RICAN FAMILY INSTITUTE

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	251S00000X	Community/Behavioral Health Agency	37PC00369900	NJ

General Provider Information

NPI Number	:	1730469891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUERTO RICAN FAMILY INSTITUTE

Provider Business Mailing Address
First Line	:	35 JOURNAL SQ
Second Line	:	SUITE 528
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-4007
Country	:	US
Telephone Number	:	201-610-1446
Fax Number	:	201-610-9426

Provider Business Practice Location Address
First Line	:	35 JOURNAL SQ
Second Line	:	SUITE 528
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-4007
Country	:	US
Telephone Number	:	201-610-1446
Fax Number	:	201-610-9426

Authorized Official
Title or Position	:	DIRECTOR
Name	:	FRANK R SOLANO
Credential	:	PHD
Telephone Number	:	201-610-1446

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	08/22/2011

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