Provider Demographics
NPI:1801461157
Name:PBNJ ENTERPRISES, LLC
Entity type:Organization
Organization Name:PBNJ ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSCELYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-249-2010
Mailing Address - Street 1:108 MORNINGSTAR CT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-4957
Mailing Address - Country:US
Mailing Address - Phone:716-490-0506
Mailing Address - Fax:
Practice Address - Street 1:1940 KENMORE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14217-2525
Practice Address - Country:US
Practice Address - Phone:716-249-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)