Provider Demographics
NPI:1942486089
Name:JNJ HOME HEALTH AIDE AGENCY
Entity Type:Organization
Organization Name:JNJ HOME HEALTH AIDE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZELAIS
Authorized Official - Suffix:
Authorized Official - Credentials:BIOLOGIST
Authorized Official - Phone:718-377-3201
Mailing Address - Street 1:5223 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3907
Mailing Address - Country:US
Mailing Address - Phone:718-377-3201
Mailing Address - Fax:
Practice Address - Street 1:5223 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3907
Practice Address - Country:US
Practice Address - Phone:718-377-3201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0875L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02077085Medicaid