| Tidal Aba Nj Llc | |
|
820 Bear Tavern Rd Ewing NJ 08628-1021 | |
| (718) 736-5689 | |
| Not Available |
| Full Name | Tidal Aba Nj Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 820 Bear Tavern Rd, Ewing, New Jersey |
| Authorized Official Name and Position | Jack Bravmann (CONTROLLER) |
| Authorized Official Contact | 7186756957 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidal Aba Nj Llc 600 Bayview Ave Ste 400 Inwood NY 11096-1606 Ph: (718) 675-6957 | Tidal Aba Nj Llc 820 Bear Tavern Rd Ewing NJ 08628-1021 Ph: (718) 736-5689 |
| NPI Number | 1811751415 |
|---|---|
| Provider Enumeration Date | 02/13/2024 |
| Last Update Date | 02/13/2024 |
| Certification Date | 02/13/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811751415 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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