Healthcare Provider Details

I. General information

NPI: 1942349402
Provider Name (Legal Business Name): PERSONAL INTERNATIONAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 CANISTEAR RD
HIGHLAND LAKES NJ
07422-2088
US

IV. Provider business mailing address

PO BOX 1033
HIGHLAND LAKES NJ
07422-4033
US

V. Phone/Fax

Practice location:
  • Phone: 973-764-9001
  • Fax: 973-764-9005
Mailing address:
  • Phone: 973-764-9001
  • Fax: 973-764-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSC14223
License Number StateNJ

VIII. Authorized Official

Name: MS. MIRIAM DIVINSKY
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 973-764-9001