Provider Demographics
NPI:1669533246
Name:ADVANCED SERVICES INTERNATIONAL, INC.
Entity type:Organization
Organization Name:ADVANCED SERVICES INTERNATIONAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YURY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-209-0001
Mailing Address - Street 1:49-51 MORTON PLACE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1605
Mailing Address - Country:US
Mailing Address - Phone:201-209-0001
Mailing Address - Fax:201-209-1333
Practice Address - Street 1:49 MORTON PL # 51
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1605
Practice Address - Country:US
Practice Address - Phone:201-209-0001
Practice Address - Fax:201-209-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
NJ4082000251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0010235Medicaid