Healthcare Provider Details

I. General information

NPI: 1851779755
Provider Name (Legal Business Name): ROYLETA FOSTER MED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 11/17/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 EVERGREEN PL STE 600
EAST ORANGE NJ
07018-2011
US

IV. Provider business mailing address

134 EVERGREEN PL STE 600
EAST ORANGE NJ
07018-2011
US

V. Phone/Fax

Practice location:
  • Phone: 862-253-6722
  • Fax: 877-308-0406
Mailing address:
  • Phone: 862-253-6722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: