| 250 Highland Ave Llc | |
|
2115 Millburn Avenue Maplewood NJ 07040 | |
| (973) 592-1512 | |
| Not Available |
| Full Name | 250 Highland Ave Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2115 Millburn Avenue, Maplewood, New Jersey |
| Authorized Official Name and Position | William Carr (OWNER) |
| Authorized Official Contact | 9735921512 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 250 Highland Ave Llc 41 Watchung Plz Ste 189 Montclair NJ 07042-4117 Ph: (973) 592-1512 | 250 Highland Ave Llc 2115 Millburn Avenue Maplewood NJ 07040 Ph: (973) 592-1512 |
| NPI Number | 1093579039 |
|---|---|
| Provider Enumeration Date | 02/09/2024 |
| Last Update Date | 02/09/2024 |
| Certification Date | 02/08/2024 |
| Medicare PECOS PAC ID | 6709221161 |
|---|---|
| Medicare Enrollment ID | O20240226002875 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093579039 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | William Edgar Carr |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265871669 PECOS PAC ID: 6406177021 Enrollment ID: I20150609000121 |
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