1225396658 NPI number — BELMAR PEDIATRIC DAY CARE I LLC

Table of content: (NPI 1225396658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225396658 NPI number — BELMAR PEDIATRIC DAY CARE I LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELMAR PEDIATRIC DAY CARE I LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE MILLHOUSE PEDIATRIC DAY HEALTH SERVICE PROGRAM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225396658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 SYLVAN AVENUE C/O CONTINUUM HEALTHCARE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ENGLEWOOD CLIFFS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-570-6018
Provider Business Mailing Address Fax Number:
201-266-9487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 JERSEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRENTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08611-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-570-6018
Provider Business Practice Location Address Fax Number:
201-266-9487
Provider Enumeration Date:
04/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DANIEL BRUCKSTEIN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
516-507-8465

Provider Taxonomy Codes

  • Taxonomy code: 261QM3000X , with the licence number:  478312 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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