Healthcare Provider Details

I. General information

NPI: 1316690159
Provider Name (Legal Business Name): DOORLAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S GLEN RD
KINNELON NJ
07405-2715
US

IV. Provider business mailing address

67 S GLEN RD
KINNELON NJ
07405-2715
US

V. Phone/Fax

Practice location:
  • Phone: 973-757-4153
  • Fax:
Mailing address:
  • Phone: 973-757-4153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: YAMILKA PENA
Title or Position: PRESIDENT
Credential:
Phone: 973-757-4153