Provider Demographics
NPI:1407389828
Name:NJ GOLDEN HOME CARE CORP
Entity Type:Organization
Organization Name:NJ GOLDEN HOME CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HATEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELAZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-390-8768
Mailing Address - Street 1:60 SICARD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1143
Mailing Address - Country:US
Mailing Address - Phone:201-918-2866
Mailing Address - Fax:201-984-0700
Practice Address - Street 1:60 SICARD ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1143
Practice Address - Country:US
Practice Address - Phone:201-918-2866
Practice Address - Fax:201-984-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0209000251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0547166Medicaid