Presbyterian Home at Monmouth

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PRESBYTERIAN HOME AT MONMOUTH

Practice address

2021 Highway 35
Wall Township, NJ 07719-3539

Phone

(732) 282-1910

Fax

(732) 282-1914

NPI assigned

Oct 4, 2005

Last updated

May 14, 2008By 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

Mr. Gary Puma

Title

President/Ceo

Phone

(609) 987-8900

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Brandywine Senior Living at Wall2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Brandywine Senior Living at Wall

  • Assisted Living Facility
  • Wall Township, NJ
  • NPI 1558642603
  NPD tax ID

Locations

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1558358648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 ROSZEL RD",
            "address_2": "SUITE C120",
            "city": "PRINCETON",
            "state": "NJ",
            "postal_code": "085406211",
            "telephone_number": "609-987-8900",
            "fax_number": "609-720-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 HIGHWAY 35",
            "city": "WALL TOWNSHIP",
            "state": "NJ",
            "postal_code": "077193539",
            "telephone_number": "732-282-1910",
            "fax_number": "732-282-1914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HOME AT MONMOUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "PUMA",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "609-987-8900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0003298",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hailee Porricelli
• Heather M Porter, PA-C
• Daniel Joseph Potoczniak, PH.D.
• Premier Shore Medical LLC
• Premise Health of New Jersey Medical PC (Horizon BCBS of NJ - Wall Health Center)
• Mitchell R Preston
• Kimberly Ann Puleo
• Sergei A Pushilin, M.D.
• Rebecca Criswell Quigley
• Nicole Quinn

• Assisted Living Facility in Wall Township, NJ
• Providers in Wall Township, NJ by specialty
• Assisted Living Facility in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.