Provider Demographics
NPI:1043228430
Name:MR OF TEANECK LLC
Entity Type:Organization
Organization Name:MR OF TEANECK LLC
Other - Org Name:TEANECK NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FISCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RISPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-488-6789
Mailing Address - Street 1:1 UNIVERSITY PLZ
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6201
Mailing Address - Country:US
Mailing Address - Phone:201-488-6789
Mailing Address - Fax:201-488-7734
Practice Address - Street 1:1104 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4800
Practice Address - Country:US
Practice Address - Phone:201-833-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ060217314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4463901Medicaid
NJ315037Medicare ID - Type Unspecified