MEDICARE: GOOD NEIGHBOR SUPPORT SERVICES

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	251B00000X	Case Management Agency		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

General Provider Information

NPI Number	:	1760924823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD NEIGHBOR SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	326 WASHINGTON ST
Second Line	:
City	:	RAHWAY
State	:	NJ
Zip	:	07065-5139
Country	:	US
Telephone Number	:	718-710-2234
Fax Number	:	732-827-5932

Provider Business Practice Location Address
First Line	:	326 WASHINGTON ST
Second Line	:
City	:	RAHWAY
State	:	NJ
Zip	:	07065-5139
Country	:	US
Telephone Number	:	718-710-2234
Fax Number	:	732-827-5932

Authorized Official
Title or Position	:	SUPPORT CORDINATOR SUPERVISOR
Name	:	MRS. TOSIN ADEGBOYEGA
Credential	:	MS
Telephone Number	:	718-710-2234

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	11/07/2016

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Directions to “GOOD NEIGHBOR SUPPORT SERVICES ” Practice Location

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