Nickjax LLC

NPI #1992070056 in New York, New York

Provider Information

NPI Number: 1992070056
Entity Type: Organization
Organization Name: Nickjax LLC
Primary Specialty: Program of All-Inclusive Care for the Elderly (PACE) Provider Organization
Enumeration Date: Mar 21, 2012
Last Updated: Mar 21, 2012

Practice Location

Address: 115 E 82ND ST
Address 2: 1B
City: New York
State: New York
ZIP Code: 10028-0831
Phone: (212) 738-9264

Authorized Official

Name: MR. RICHARD MANCUSO
Title: EXECUTIVE DIRECTOR
Phone: (212) 738-9264

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization	251T00000X	Primary

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