Basic Information
Provider Information | |||||||||
NPI: | 1609807395 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BAYADA NURSES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 101 EXECUTIVE DR | ||||||||
Address2: | SUITE 4 | ||||||||
City: | MOORESTOWN | ||||||||
State: | NJ | ||||||||
PostalCode: | 080574236 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8567931703 | ||||||||
FaxNumber: | 8564390412 | ||||||||
Practice Location | |||||||||
Address1: | 1261 S ROUTE 9 | ||||||||
Address2: | SUITE 3 | ||||||||
City: | CAPE MAY COURT HOUSE | ||||||||
State: | NJ | ||||||||
PostalCode: | 082102761 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6094650755 | ||||||||
FaxNumber: | 6094650251 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/05/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FLANNERY | ||||||||
AuthorizedOfficialFirstName: | STEPHEN | ||||||||
AuthorizedOfficialMiddleName: | P | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF REIMBURSEMENT | ||||||||
AuthorizedOfficialTelephone: | 8567931703 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | HP0015316 | NJ | Y |   | Agencies | Home Health |   |
ID Information
ID | Type | State | Issuer | Description | 115652 | 01 | NJ | CAREMARK, INC | OTHER | 47412 | 01 | NJ | KEYSTONE MERCY HEALTH PLA | OTHER | 0L0714 | 01 | NJ | ACS/HEALTH NET | OTHER | 68746 | 01 | NJ | AETNA/US HEALTHCARE | OTHER | 81CN5R | 01 | NJ | DDD | OTHER | A10008 | 01 | NJ | MID-ATLANTIC HEALTH PLAN | OTHER | A476325 | 01 | NJ | OXFORD HEALTH PLAN | OTHER | 000763 | 01 | NJ | HORIZON HEALTHCARE - NY | OTHER | 8293708 | 05 | NJ |   | MEDICAID | 0004461000 | 01 | NJ | AMERIHEALTH - NJ | OTHER | 25626 | 01 | NJ | COVENTRY HEALTH CARE | OTHER | 803200Z4646100 | 01 | NJ | EMPIRE BC/BS | OTHER | 819074 | 01 | NJ | HORIZON BC/BS OF NJ | OTHER | 37545 | 01 | NJ | AMERIGROUP NEW JERSEY | OTHER | YVPH8N | 01 | NJ | DYFS | OTHER | 1504904 | 01 | NJ | MAGNACARE | OTHER | 1024958 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 228865 | 01 | NJ | MAMSI | OTHER |