Provider Demographics
NPI:1558430140
Name:PRESBYTERIAN HOME AT WATCHUNG, INC
Entity Type:Organization
Organization Name:PRESBYTERIAN HOME AT WATCHUNG, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-987-8900
Mailing Address - Street 1:13 ROSZEL RD
Mailing Address - Street 2:SUITE C120
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6211
Mailing Address - Country:US
Mailing Address - Phone:609-987-8900
Mailing Address - Fax:609-720-7247
Practice Address - Street 1:680 MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6270
Practice Address - Country:US
Practice Address - Phone:908-754-8180
Practice Address - Fax:908-754-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8687404Medicaid