| Sa621 | |
|
556 Walnut St Fl 1 Elizabeth NJ 07201-1105 | |
| (973) 703-6667 | |
| Not Available |
| Full Name | Sa621 |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 556 Walnut St Fl 1, Elizabeth, New Jersey |
| Authorized Official Name and Position | Christina Martin (ADVISOR) |
| Authorized Official Contact | 9737036667 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sa621 49 Woodbridge Ave Highland Park NJ 08904-3236 Ph: () - | Sa621 556 Walnut St Fl 1 Elizabeth NJ 07201-1105 Ph: (973) 703-6667 |
| NPI Number | 1720629645 |
|---|---|
| Provider Enumeration Date | 10/02/2019 |
| Last Update Date | 03/03/2022 |
| Certification Date | 03/03/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720629645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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