Healthcare Provider Details

I. General information

NPI: 1063194066
Provider Name (Legal Business Name): MS. SAROYA Y BRAXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 SPRINGFIELD AVE
IRVINGTON NJ
07111-1362
US

IV. Provider business mailing address

1344 SPRINGFIELD AVE
IRVINGTON NJ
07111-1362
US

V. Phone/Fax

Practice location:
  • Phone: 973-399-7900
  • Fax: 973-399-1705
Mailing address:
  • Phone: 973-399-7900
  • Fax: 973-399-1705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: