| Avita Icare | |
|
440 West St Ste 312 Fort Lee NJ 07024-5028 | |
| (888) 242-2732 | |
| (888) 242-2732 |
| Full Name | Avita Icare |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 440 West St Ste 312, Fort Lee, New Jersey |
| Authorized Official Name and Position | Kalman Khodik (OWNER/CLINICAL DIRECTOR) |
| Authorized Official Contact | 8882422732 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avita Icare 440 West St Ste 312 Fort Lee NJ 07024-5028 Ph: (888) 242-2732 | Avita Icare 440 West St Ste 312 Fort Lee NJ 07024-5028 Ph: (888) 242-2732 |
| NPI Number | 1821530148 |
|---|---|
| Provider Enumeration Date | 11/17/2016 |
| Last Update Date | 06/13/2022 |
| Certification Date | 06/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821530148 | NPI | - | NPPES |
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