NPIMap

Organization Active NPI

PPMD West Berlin 1St Floor

  • Adult Day Care Clinic/Center
  • West Berlin, NJ
National Provider Identifier
1821496712
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Day Care Clinic/CenterTaxonomy code 261QA0600X
License
04012 Issued in NJ
Legal business name
PPMD WEST BERLIN 1ST FLOOR
Practice address
411 Commerce LN
First Floor
West Berlin, NJ 08091-9254
Phone
(856) 753-7935
Fax
(856) 753-7714
NPI assigned
Dec 9, 2014
Organization subpart
Yes
Parent organization
PROVIDENCE PEDIATRIC MEDICAL DAYCARE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

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

Authorized official

Name
Mrs. Leeanna Roman-Lozada
Title
Precident / Ceo
Phone
(856) 753-7763

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Day Care Clinic/Center 261QA0600X 04012 NJ Primary

Addresses

Primary practice location

411 Commerce LN
First Floor
West Berlin, NJ 08091-9254

Mailing address

411 Commerce LN
West Berlin, NJ 08091-9254
Phone (856) 753-7763

Other names 1

  • Providence Pediatric Medical DayCare Inc. Other name

National Provider Directory

National Provider Directory
Tax ID family
PPMD West Berlin 1St Floor4 organizations share this tax ID, including this one
Part of
PPMD West Berlin 1St Floor

Other organizations with this tax ID 3

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

Locations

411 Commerce Ln
Fl First
West Berlin, NJ 08091
Phone (856) 753-7935

NPI Registry JSON

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1821496712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 COMMERCE LN",
            "city": "WEST BERLIN",
            "state": "NJ",
            "postal_code": "080919254",
            "telephone_number": "856-753-7763",
            "fax_number": "856-753-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 COMMERCE LN",
            "address_2": "FIRST FLOOR",
            "city": "WEST BERLIN",
            "state": "NJ",
            "postal_code": "080919254",
            "telephone_number": "856-753-7935",
            "fax_number": "856-753-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PPMD WEST BERLIN 1ST FLOOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE PEDIATRIC MEDICAL DAYCARE INC.",
        "enumeration_date": "2014-12-09",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "ROMAN-LOZADA",
        "authorized_official_first_name": "LEEANNA",
        "authorized_official_title_or_position": "PRECIDENT / CEO",
        "authorized_official_telephone_number": "856-753-7763",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NJ",
            "license": "04012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Pediatric Medical DayCare Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West Berlin, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; 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.