| Great Moments | |
|
88 W Ridgewood Ave Ridgewood NJ 07450-3199 | |
| (201) 757-0600 | |
| (800) 507-2456 |
| Full Name | Great Moments |
|---|---|
| Speciality | Psychologist |
| Location | 88 W Ridgewood Ave, Ridgewood, New Jersey |
| Authorized Official Name and Position | Ida Jeltova (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2017570600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Moments 88 W Ridgewood Ave Ridgewood NJ 07450-3199 Ph: (201) 757-0600 | Great Moments 88 W Ridgewood Ave Ridgewood NJ 07450-3199 Ph: (201) 757-0600 |
| NPI Number | 1396409645 |
|---|---|
| Provider Enumeration Date | 10/22/2021 |
| Last Update Date | 11/19/2021 |
| Certification Date | 11/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396409645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
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