Healthcare Provider Details

I. General information

NPI: 1942130919
Provider Name (Legal Business Name): MTN ORGANIZATION ,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WESTLAKE CT
JACKSON NJ
08527-5160
US

IV. Provider business mailing address

25 WESTLAKE CT
JACKSON NJ
08527-5160
US

V. Phone/Fax

Practice location:
  • Phone: 732-207-4588
  • Fax:
Mailing address:
  • Phone: 732-207-4588
  • Fax:

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: YVETTE ANDERSON
Title or Position: CEO
Credential:
Phone: 732-207-4588