Healthcare Provider Details

I. General information

NPI: 1699597625
Provider Name (Legal Business Name): ADVANCED THERAPEUTIC MODALITIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 HUDSON ST
HACKENSACK NJ
07601-6943
US

IV. Provider business mailing address

666 YORKTOWN PL
PARAMUS NJ
07652-2208
US

V. Phone/Fax

Practice location:
  • Phone: 908-456-0600
  • Fax:
Mailing address:
  • Phone: 908-456-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
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: MARIE ANN ADDESA
Title or Position: NURSE PRACTITIONER
Credential: APN
Phone: 908-456-0060