1063873453 NPI number — OPTIONS COUNSELING, INC

Table of content: (NPI 1063873453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063873453 NPI number — OPTIONS COUNSELING, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIONS COUNSELING, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OPTIONS COUNSELING CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063873453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 CALVIN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METUCHEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08840-2450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-549-0401
Provider Business Mailing Address Fax Number:
732-549-4446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 W BROADWAY
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
PATERSON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07505-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-345-1883
Provider Business Practice Location Address Fax Number:
973-345-5480
Provider Enumeration Date:
03/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CONTE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
OPERATIONS DIRECTOR
Authorized Official Telephone Number:
973-445-8202

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  2000024 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1609036841 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043350333 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com