Provider Demographics
NPI:1942678396
Name:BEACON OF LIFE CENTRAL NJ
Entity Type:Organization
Organization Name:BEACON OF LIFE CENTRAL NJ
Other - Org Name:BEACON OF LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CZERMAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-806-3224
Mailing Address - Street 1:1075 STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757
Mailing Address - Country:US
Mailing Address - Phone:732-806-3223
Mailing Address - Fax:732-806-3224
Practice Address - Street 1:1075 STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757
Practice Address - Country:US
Practice Address - Phone:732-806-3223
Practice Address - Fax:732-806-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH9323Medicare UPIN