Provider Demographics
NPI:1871827196
Name:SENIORS ON THE GO OF SJ INC.
Entity Type:Organization
Organization Name:SENIORS ON THE GO OF SJ INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-569-0443
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:175 N. MAIN ST.
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-0737
Mailing Address - Country:US
Mailing Address - Phone:609-569-0443
Mailing Address - Fax:609-641-2460
Practice Address - Street 1:175 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-2561
Practice Address - Country:US
Practice Address - Phone:609-569-0443
Practice Address - Fax:609-641-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0991640001Medicare NSC