Provider Demographics
NPI:1225396658
Name:BELMAR PEDIATRIC DAY CARE I LLC
Entity type:Organization
Organization Name:BELMAR PEDIATRIC DAY CARE I LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIEL BRUCKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:516-507-8465
Mailing Address - Street 1:180 SYLVAN AVENUE C/O CONTINUUM HEALTHCARE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632
Mailing Address - Country:US
Mailing Address - Phone:718-570-6018
Mailing Address - Fax:201-266-9487
Practice Address - Street 1:325 JERSEY STREET
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-3113
Practice Address - Country:US
Practice Address - Phone:718-570-6018
Practice Address - Fax:201-266-9487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ478312261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care