Provider Demographics
NPI:1093911042
Name:JEWISH COMMUNITY CENTER ON THE PALISADES
Entity Type:Organization
Organization Name:JEWISH COMMUNITY CENTER ON THE PALISADES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, KAPLEN ADULT REACH CENTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:201-569-7900
Mailing Address - Street 1:411 E CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2319
Mailing Address - Country:US
Mailing Address - Phone:201-569-7900
Mailing Address - Fax:201-569-7448
Practice Address - Street 1:411 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2319
Practice Address - Country:US
Practice Address - Phone:201-569-7900
Practice Address - Fax:201-569-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8903506Medicaid