Provider Demographics
NPI:1013372457
Name:SEWELL SENIOR CITIZEN CENTER
Entity Type:Organization
Organization Name:SEWELL SENIOR CITIZEN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-284-6020
Mailing Address - Street 1:2 RALEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-7906
Mailing Address - Country:US
Mailing Address - Phone:732-284-6020
Mailing Address - Fax:267-878-0160
Practice Address - Street 1:475 HURSTVILLE CROSS KEYS RD
Practice Address - Street 2:SUITE A&B
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:732-284-6020
Practice Address - Fax:267-878-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization