Provider Demographics
NPI:1770908642
Name:NJ COMMUNITY CARE CENTER
Entity type:Organization
Organization Name:NJ COMMUNITY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:V
Authorized Official - Last Name:GIARDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-908-7700
Mailing Address - Street 1:864 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5033
Mailing Address - Country:US
Mailing Address - Phone:732-908-7700
Mailing Address - Fax:732-503-4127
Practice Address - Street 1:864 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5033
Practice Address - Country:US
Practice Address - Phone:732-908-7700
Practice Address - Fax:732-503-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00244100363AM0700X
NJ26NN05182000363LF0000X
NJ25MP00217100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty