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200 Middlesex Essex Tpke Ste 304 Iselin NJ 08830-2033 | |
| (732) 455-2343 | |
| (732) 860-1350 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 200 Middlesex Essex Tpke Ste 304, Iselin, New Jersey |
| Authorized Official Name and Position | Igor Ravinsky (OWNER) |
| Authorized Official Contact | 9173557104 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
435 Hampton Ct Manalapan NJ 07726-3280 Ph: (917) 355-7104 | 200 Middlesex Essex Tpke Ste 304 Iselin NJ 08830-2033 Ph: (732) 455-2343 |
| NPI Number | 1760965065 |
|---|---|
| Provider Enumeration Date | 09/12/2018 |
| Last Update Date | 01/10/2025 |
| Certification Date | 01/10/2025 |
| Medicare PECOS PAC ID | 8527304062 |
|---|---|
| Medicare Enrollment ID | O20241127000641 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760965065 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Jessica M Plonchak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750837803 PECOS PAC ID: 4486907482 Enrollment ID: I20181022000387 |
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