Healthcare Provider Details

I. General information

NPI: 1386082907
Provider Name (Legal Business Name): CATHOLIC CHARITIES DIOCESE OF METUCHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SAFRAN AVE
EDISON NJ
08837-3510
US

IV. Provider business mailing address

26 SAFRAN AVE
EDISON NJ
08837-3510
US

V. Phone/Fax

Practice location:
  • Phone: 732-738-1323
  • Fax: 732-738-3896
Mailing address:
  • Phone: 732-738-1323
  • Fax: 732-738-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number37AC00142600
License Number StateNJ

VIII. Authorized Official

Name: DESI ISIDRO
Title or Position: CLINICAL SUPERVISOR
Credential:
Phone: 732-738-1323