| Njcri | |
|
393 Central Ave Newark NJ 07103-2842 | |
| (973) 483-3444 | |
| Not Available |
| Full Name | Njcri |
|---|---|
| Speciality | Clinic/Center |
| Location | 393 Central Ave, Newark, New Jersey |
| Authorized Official Name and Position | Corey Lyn Destefano (CLINICAL DIRECTOR) |
| Authorized Official Contact | 9734833444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Njcri 393 Central Ave Newark NJ 07103-2842 Ph: (973) 483-3444 | Njcri 393 Central Ave Newark NJ 07103-2842 Ph: (973) 483-3444 |
| NPI Number | 1568951168 |
|---|---|
| Provider Enumeration Date | 05/09/2018 |
| Last Update Date | 05/09/2018 |
| Medicare PECOS PAC ID | 2769890326 |
|---|---|
| Medicare Enrollment ID | O20210420001217 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568951168 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 101430204 (New Jersey) | Primary |
| Provider Name | Edward Brazaitis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972614394 PECOS PAC ID: 4486836616 Enrollment ID: I20110309000949 |
| Provider Name | David Alabi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942645544 PECOS PAC ID: 7719128271 Enrollment ID: I20130920000551 |
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