Healthcare Provider Details

I. General information

NPI: 1932099264
Provider Name (Legal Business Name): NURTURED NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 ROUTE 18 STE 3000 SOUTH TOWER
EAST BRUNSWICK NJ
08816-1440
US

IV. Provider business mailing address

197 ROUTE 18 STE 3000 SOUTH TOWER
EAST BRUNSWICK NJ
08816-1440
US

V. Phone/Fax

Practice location:
  • Phone: 732-336-1908
  • Fax:
Mailing address:
  • Phone: 732-336-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMANI F HOLLOWAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 732-336-1908