Healthcare Provider Details

I. General information

NPI: 1023695491
Provider Name (Legal Business Name): EMPOWER U OUTPATIENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY RD STE 92
HAZLET NJ
07730-1669
US

IV. Provider business mailing address

43 GRAND COVE WAY
EDGEWATER NJ
07020-7223
US

V. Phone/Fax

Practice location:
  • Phone: 855-500-8348
  • Fax: 855-500-3848
Mailing address:
  • Phone: 908-907-7777
  • Fax: 855-500-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MARLON W GRAY
Title or Position: MANAGING PARTNER
Credential: EDD
Phone: 908-907-7777