Provider Demographics
NPI:1194888008
Name:GUARDIAN ELDERCARE PC
Entity type:Organization
Organization Name:GUARDIAN ELDERCARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-368-9680
Mailing Address - Street 1:161 MAIN ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7145
Mailing Address - Country:US
Mailing Address - Phone:201-368-9680
Mailing Address - Fax:201-342-2373
Practice Address - Street 1:161 MAIN ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7145
Practice Address - Country:US
Practice Address - Phone:201-368-9680
Practice Address - Fax:201-342-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ049486Medicare ID - Type UnspecifiedPSYCHOLOGICAL SERVICES