Healthcare Provider Details

I. General information

NPI: 1538547112
Provider Name (Legal Business Name): HEALTHY LIVING FAMILY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 SANFORD ST
EAST ORANGE NJ
07018-1927
US

IV. Provider business mailing address

84 SANFORD ST
EAST ORANGE NJ
07018-1927
US

V. Phone/Fax

Practice location:
  • Phone: 862-955-3232
  • Fax: 862-772-4820
Mailing address:
  • Phone: 862-955-3232
  • Fax: 862-772-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number25MA08826900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MP00192500
License Number StateNJ

VIII. Authorized Official

Name: DR. GARDY VALENTIN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 862-955-3232