1750376133 NPI number — JSAS HEALTHCARE, INC.

Table of content: (NPI 1750376133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750376133 NPI number — JSAS HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JSAS HEALTHCARE, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1750376133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
685 NEPTUNE BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
NEPTUNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07753-4118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-988-8877
Provider Business Mailing Address Fax Number:
732-988-2572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
685 NEPTUNE BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-4118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-988-8877
Provider Business Practice Location Address Fax Number:
732-988-2572
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VILLARI
Authorized Official First Name:
DIANE
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPUTY EXECUTIVE/COO
Authorized Official Telephone Number:
732-988-8877

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , with the licence number:  41340 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0102806 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7632801 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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