Organization
MI CASA ES SU CASA II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTONIO GINES MD (OWNER/CEO)
(201) 652-8434
Entity
Organization
Contact information
Practice address
30 S MAPLE AVE, RIDGEWOOD, NJ 07450-4508
(201) 652-8434
(201) 652-0194
Mailing address
6120 BUCHANAN PL, WEST NEW YORK, NJ 07093-2915
(201) 652-8434
(201) 652-0194
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
NJ09001
NJ
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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