Provider Demographics
NPI:1447628177
Name:NEPTUNE GARDENS NURSING AND REHAB LLC
Entity type:Organization
Organization Name:NEPTUNE GARDENS NURSING AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMZEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-774-3550
Mailing Address - Street 1:101 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4301
Mailing Address - Country:US
Mailing Address - Phone:732-774-3550
Mailing Address - Fax:
Practice Address - Street 1:101 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4301
Practice Address - Country:US
Practice Address - Phone:732-774-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ061304314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ061304OtherLICENSE NUMBER
NJ315056Medicare Oscar/Certification