Provider Demographics
NPI:1417095324
Name:BROADWAY ADULT MEDICAL DAY CARE INC
Entity Type:Organization
Organization Name:BROADWAY ADULT MEDICAL DAY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:
Authorized Official - Last Name:SELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-797-1177
Mailing Address - Street 1:24-20 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3057
Mailing Address - Country:US
Mailing Address - Phone:201-797-1177
Mailing Address - Fax:201-796-3344
Practice Address - Street 1:24-20 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3057
Practice Address - Country:US
Practice Address - Phone:201-797-1177
Practice Address - Fax:201-796-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJYT613N261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8803404Medicaid