Healthcare Provider Details

I. General information

NPI: 1730658774
Provider Name (Legal Business Name): FAMILY SERVICE BUREAU OF NEWARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 KEARNY AVE
KEARNY NJ
07032-2601
US

IV. Provider business mailing address

274 S ORANGE AVE
NEWARK NJ
07103-2419
US

V. Phone/Fax

Practice location:
  • Phone: 201-246-8077
  • Fax: 201-955-6165
Mailing address:
  • Phone: 973-412-2056
  • Fax: 973-484-3452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHI SHU CHOU
Title or Position: DIRECTOR OF OPERATIONS
Credential: LPC, LCADC
Phone: 973-412-2056