Provider Demographics
NPI:1932261245
Name:JEWISH OLDER ADULT SERVICES OF ATLANTIC COUNTY INC
Entity Type:Organization
Organization Name:JEWISH OLDER ADULT SERVICES OF ATLANTIC COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-345-5555
Mailing Address - Street 1:1102 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-4803
Mailing Address - Country:US
Mailing Address - Phone:609-345-8409
Mailing Address - Fax:609-345-7024
Practice Address - Street 1:1102 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-4803
Practice Address - Country:US
Practice Address - Phone:609-345-8409
Practice Address - Fax:609-345-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0028100Medicaid
NJ481309Medicare ID - Type Unspecified