Provider Demographics
NPI:1275723785
Name:JANETTE NUTLEY CENTER
Entity Type:Organization
Organization Name:JANETTE NUTLEY CENTER
Other - Org Name:JNC
Other - Org Type:Other Name
Authorized Official - Title/Position:SALES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:973-667-1900
Mailing Address - Street 1:242 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2709
Mailing Address - Country:US
Mailing Address - Phone:973-667-1900
Mailing Address - Fax:972-667-9194
Practice Address - Street 1:242 FRANKLIN AVE
Practice Address - Street 2:N/A
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2709
Practice Address - Country:US
Practice Address - Phone:973-667-1900
Practice Address - Fax:972-667-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0707220001Medicare NSC