Beacon of Life North NJ LLC

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

Legal business name

BEACON OF LIFE NORTH NJ LLC

Doing business as

BoldAge PACE North NJ

Practice address

25 Kennedy Blvd
E Brunswick, NJ 08816-1259

Phone

(732) 806-3205

NPI assigned

Aug 14, 2024

Last updated

Apr 10, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Czermak

Title

Chief Administrative Officer

Phone

(855) 801-2653

Specialties & licenses 1

Addresses

Other names 2

• BoldAge PACE North NJ Doing business as
• BoldAge PACE Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744243200000",
    "number": "1063244630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 W MOORE AVE",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281153551",
            "telephone_number": "732-806-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 KENNEDY BLVD",
            "city": "E BRUNSWICK",
            "state": "NJ",
            "postal_code": "088161259",
            "telephone_number": "732-806-3205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON OF LIFE NORTH NJ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-14",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A",
        "authorized_official_last_name": "CZERMAK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "855-801-2653"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BoldAge PACE North NJ",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BoldAge PACE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• PACE Provider Organization in E Brunswick, NJ
• Providers in E Brunswick, NJ by specialty
• PACE Provider Organization in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.