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541 Cedar Hill Ave Ste 2 Wyckoff NJ 07481-2133 | |
| (551) 444-0924 | |
| (866) 315-8961 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 541 Cedar Hill Ave Ste 2, Wyckoff, New Jersey |
| Authorized Official Name and Position | Daniel Defeo (MANAGING MEMBER) |
| Authorized Official Contact | 5515005708 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
541 Cedar Hill Ave Ste 2 Wyckoff NJ 07481-2133 Ph: (551) 444-0924 | 541 Cedar Hill Ave Ste 2 Wyckoff NJ 07481-2133 Ph: (551) 444-0924 |
| NPI Number | 1902598311 |
|---|---|
| Provider Enumeration Date | 05/24/2023 |
| Last Update Date | 01/30/2024 |
| Certification Date | 01/30/2024 |
| Medicare PECOS PAC ID | 4385184019 |
|---|---|
| Medicare Enrollment ID | O20240910000064 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902598311 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Lorelle R Holway |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932322773 PECOS PAC ID: 8628127115 Enrollment ID: I20090512000222 |
| Provider Name | Daniel S De Feo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912147166 PECOS PAC ID: 2668640624 Enrollment ID: I20130904000817 |
| Provider Name | Jennifer Walsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952633224 PECOS PAC ID: 8527394493 Enrollment ID: I20190730003512 |
| Provider Name | James Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306568084 PECOS PAC ID: 3678940368 Enrollment ID: I20221109002612 |
| Provider Name | Adelina Garabet-mitchell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023692191 PECOS PAC ID: 5698213569 Enrollment ID: I20240812000370 |
| Provider Name | Justin Liegmann |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1750513099 PECOS PAC ID: 6800020983 Enrollment ID: I20241002000071 |
| Provider Name | Gladys Santiago Fernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700562774 PECOS PAC ID: 6901331347 Enrollment ID: I20241122000830 |
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