Provider Demographics
NPI:1447391230
Name:LONG LIFE ADULT DAY CARE, PC
Entity Type:Organization
Organization Name:LONG LIFE ADULT DAY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-943-7111
Mailing Address - Street 1:596 ANDERSON AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1831
Mailing Address - Country:US
Mailing Address - Phone:201-943-7111
Mailing Address - Fax:201-943-8859
Practice Address - Street 1:596 ANDERSON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-1831
Practice Address - Country:US
Practice Address - Phone:201-943-7111
Practice Address - Fax:201-943-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
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
NJ058100OtherSTATE LICENSE NUMBER
NJ8117900Medicaid