Healthcare Provider Details

I. General information

NPI: 1821758434
Provider Name (Legal Business Name): ALL ACCESS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ELY PL
EDISON NJ
08817-3005
US

IV. Provider business mailing address

1906 53RD ST
BROOKLYN NY
11204-1743
US

V. Phone/Fax

Practice location:
  • Phone: 917-936-6288
  • Fax:
Mailing address:
  • Phone: 347-633-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID GREENE
Title or Position: PROGRAM DIRECTOR
Credential: LCSW
Phone: 917-936-6288