Healthcare Provider Details

I. General information

NPI: 1588220552
Provider Name (Legal Business Name): HEALTHWORKSPRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N 14TH ST
EAST ORANGE NJ
07017-5112
US

IV. Provider business mailing address

85 N 14TH ST
EAST ORANGE NJ
07017-5112
US

V. Phone/Fax

Practice location:
  • Phone: 973-571-9090
  • Fax: 973-556-1194
Mailing address:
  • Phone: 973-571-9090
  • Fax: 973-556-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD CROIX COPPAGE
Title or Position: PRESIDENT
Credential: PHD
Phone: 973-571-9090