Provider Demographics
NPI:1457569311
Name:PERSONALIZED HOME CARE, LTD. OF N.J.
Entity Type:Organization
Organization Name:PERSONALIZED HOME CARE, LTD. OF N.J.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOSIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-423-6410
Mailing Address - Street 1:1 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6822
Mailing Address - Country:US
Mailing Address - Phone:914-423-6410
Mailing Address - Fax:914-423-1306
Practice Address - Street 1:73 FERRY ST # 75
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1831
Practice Address - Country:US
Practice Address - Phone:973-344-6555
Practice Address - Fax:973-344-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0102802251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ06312012Medicaid