MEDICARE: 1ST CARE NJ 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1942769930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST CARE NJ LLC

Provider Business Mailing Address
First Line	:	3919 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229
Country	:	US
Telephone Number	:	347-860-1156
Fax Number	:

Provider Business Practice Location Address
First Line	:	3919 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229
Country	:	US
Telephone Number	:	347-860-1156
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FAY S BREZEL
Credential	:	LMHC
Telephone Number	:	347-860-1156

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	03/18/2019

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