Healthcare Provider Details

I. General information

NPI: 1306762539
Provider Name (Legal Business Name): BLUE RAY ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 CLINTON AVE STE 160
IRVINGTON NJ
07111-3549
US

IV. Provider business mailing address

1064 CLINTON AVE STE 160
IRVINGTON NJ
07111-3549
US

V. Phone/Fax

Practice location:
  • Phone: 877-358-5111
  • Fax: 908-858-5500
Mailing address:
  • Phone: 877-358-5111
  • Fax: 908-858-5500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAKYRRAH COVINGTON
Title or Position: MANAGER
Credential:
Phone: 862-359-6560