Healthcare Provider Details

I. General information

NPI: 1841682986
Provider Name (Legal Business Name): DISABLED, INFORMATION, AWARENESS & LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PROSPECT VILLAGE PLZ FLOOR 1
CLIFTON NJ
07013-1952
US

IV. Provider business mailing address

2 PROSPECT VILLAGE PLZ FLOOR 1
CLIFTON NJ
07013-1952
US

V. Phone/Fax

Practice location:
  • Phone: 973-470-8090
  • Fax: 973-470-8171
Mailing address:
  • Phone: 973-470-8090
  • Fax: 973-470-8171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. JOHN PETIX JR.
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED.
Phone: 973-470-8090