Provider Demographics
NPI:1992045405
Name:JAY SHREE KRISHNA MOONACHIE LLC
Entity Type:Organization
Organization Name:JAY SHREE KRISHNA MOONACHIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PARUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGEMENT
Authorized Official - Phone:973-202-5072
Mailing Address - Street 1:311 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:MOONACHIE
Mailing Address - State:NJ
Mailing Address - Zip Code:07074-1138
Mailing Address - Country:US
Mailing Address - Phone:973-202-5072
Mailing Address - Fax:973-882-3162
Practice Address - Street 1:311 E PARK ST
Practice Address - Street 2:
Practice Address - City:MOONACHIE
Practice Address - State:NJ
Practice Address - Zip Code:07074-1138
Practice Address - Country:US
Practice Address - Phone:973-202-5072
Practice Address - Fax:973-882-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care