Healthcare Provider Details

I. General information

NPI: 1689518730
Provider Name (Legal Business Name): BAYRON D OVALLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UNIVERSITY PLZ STE 301
HACKENSACK NJ
07601-6224
US

IV. Provider business mailing address

475 HAZEL ST APT 2
CLIFTON NJ
07011-2819
US

V. Phone/Fax

Practice location:
  • Phone: 201-975-5300
  • Fax:
Mailing address:
  • Phone: 201-931-8815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00912100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: