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Organization
2ND HOME PERTH AMBOY LLC
Active
Organization
2ND HOME PERTH AMBOY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M MYERS M.D. (MEDICAL DIRECTOR)
(973) 278-7065
Entity
Organization
Contact information
Practice address
420 FAYETTE ST, PERTH AMBOY, NJ 08861-3835
(732) 826-1961
(973) 278-4773
Mailing address
100 HAMILTON PLZ, 3RD FLOOR, PATERSON, NJ 07505-2109
(973) 278-7065
(973) 278-4773
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
Z0SFLR
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7337043
—
NJ
Enumeration date
02/16/2007
Last updated
06/13/2008
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