| Organization Name: | PPMD WEST BERLIN 1ST FLOOR |
| NPI Number: | 1821496712 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LEEANNA ROMAN-LOZADA (PRECIDENT / CEO) |
| Mailing Address: | 411 Commerce Ln First Floor West Berlin |
| State: | NJ US |
| Postal Code: | 080919254 |
| Phone Number: | 8567537935 |
| Fax Number: | 8567537714 |
| NPI Enumeration Date: | 12/09/2014 |
| NPI Last Update Date: | 12/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA0600X |
| License Number: | 04012 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Day Care |
| Taxonomy Definition: | |