Healthcare Provider Details

I. General information

NPI: 1629122056
Provider Name (Legal Business Name): DAVID J GRIFFITH MS, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 W PALISADE AVE VANTAGE HEALTH SYSTEM
ENGLEWOOD NJ
07631-2611
US

IV. Provider business mailing address

50-08 W. LINDSLEY ROAD
CEDAR GROVE NJ
07009
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-0500
  • Fax: 201-567-4348
Mailing address:
  • Phone: 201-567-0500
  • Fax: 201-567-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00013000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: