Pascack Community Services

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

License

80137 Issued in NJ

Legal business name

PASCACK COMMUNITY SERVICES

Practice address

363 Old Hook Rd
Westwood, NJ 07675-3201

Phone

(201) 664-6649

Fax

(201) 664-5542

NPI assigned

Aug 24, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Susan Shannon

Title

Biller

Phone

(201) 664-1842

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• lillian booth dialysis center Doing business as

Tax ID family

Lillian Booth Dialysis Center2 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.

• Pascack Community Services, Inc.

  • Registered Dietitian
  • Westwood, NJ
  • NPI 1891917274
  NPD tax ID

Locations

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669465753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 OLD HOOK RD",
            "city": "WESTWOOD",
            "state": "NJ",
            "postal_code": "076753201",
            "telephone_number": "201-664-6649",
            "fax_number": "201-664-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 OLD HOOK RD",
            "city": "WESTWOOD",
            "state": "NJ",
            "postal_code": "076753201",
            "telephone_number": "201-664-6649",
            "fax_number": "201-664-5542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASCACK COMMUNITY SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHANNON",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "BILLER",
        "authorized_official_telephone_number": "201-664-1842",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NJ",
            "license": "80137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICHOICE",
            "identifier": "91068",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "IL00996",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2020133",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "H478876",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01560030",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE",
            "identifier": "009552",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6585701",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "lillian booth dialysis center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Danielle Panarello, LCSW
• Cheong Park, LSW
• Esther Park
• Kyungjin Park, L.AC
• Mark Park, DMD, MD
• Pascack Community Services, Inc.
• Pascack Emergency Services Inc
• Pascack Hospital Physicians Services, P.a.
• Pascack Pediatric Associates LLC
• Pascack Physician Services

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Westwood, NJ
• Providers in Westwood, NJ by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.