Healthcare Provider Details

I. General information

NPI: 1487476644
Provider Name (Legal Business Name): PATHWAY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 COOLIDGE PLACE
HACKENSACK NJ
07601
US

IV. Provider business mailing address

16 COOLIDGE PLACE
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 732-731-9617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: OLUFUNKE ADEBANJO
Title or Position: OWNER
Credential:
Phone: 469-530-4932