| Sa652 | |
|
16 Knox Terrace #2b Wayne NJ 07470 | |
| (973) 703-6667 | |
| Not Available |
| Full Name | Sa652 |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 16 Knox Terrace, Wayne, 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 |
|---|---|
| Sa652 49 Woodbridge Ave Highland Park NJ 08904-3236 Ph: (973) 703-6667 | Sa652 16 Knox Terrace #2b Wayne NJ 07470 Ph: (973) 703-6667 |
| NPI Number | 1265073183 |
|---|---|
| Provider Enumeration Date | 10/02/2019 |
| Last Update Date | 01/12/2024 |
| Certification Date | 01/12/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265073183 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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