Provider Demographics
NPI:1104005057
Name:STATE OF NEW JERSEY
Entity Type:Organization
Organization Name:STATE OF NEW JERSEY
Other - Org Name:NEW JERSEY VETERANS MEMORIAL HOME PARAMUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FEENAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-634-8509
Mailing Address - Street 1:1 VETERANS WAY
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4100
Mailing Address - Country:US
Mailing Address - Phone:201-634-8509
Mailing Address - Fax:201-967-8658
Practice Address - Street 1:1 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4100
Practice Address - Country:US
Practice Address - Phone:201-634-8509
Practice Address - Fax:201-967-8658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty