1265902373 NPI number — NEW VISION THERAPEUTIC COUNSELING SERVICES

Table of content: MR. CALEB MICHAEL MCGUIRE CRNA (NPI 1609597632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265902373 NPI number — NEW VISION THERAPEUTIC COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW VISION THERAPEUTIC COUNSELING SERVICES
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:
Provider Other Organization Name Type Code:
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:
1265902373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 EVERGREEN PL STE 3A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07018-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-951-4402
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 EVERGREEN PLACE SUITE 3A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-951-4402
Provider Business Practice Location Address Fax Number:
941-916-9902
Provider Enumeration Date:
12/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
EJIOFOR
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-674-9857

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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