Provider Demographics
NPI:1104147529
Name:POLYMART
Entity type:Organization
Organization Name:POLYMART
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:E
Authorized Official - Last Name:CECCHINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-970-6164
Mailing Address - Street 1:169 MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-4105
Mailing Address - Country:US
Mailing Address - Phone:732-970-6164
Mailing Address - Fax:732-970-6166
Practice Address - Street 1:169 MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-4105
Practice Address - Country:US
Practice Address - Phone:732-970-6164
Practice Address - Fax:732-970-6166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0139200253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care