Healthcare Provider Details

I. General information

NPI: 1811825284
Provider Name (Legal Business Name): EPIPHANY VENTURE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 ROUTE 46 E APT 15B
LODI NJ
07644-3627
US

IV. Provider business mailing address

233 COLUMBUS AVE APT 3
NEW HAVEN CT
06519-2230
US

V. Phone/Fax

Practice location:
  • Phone: 917-903-5131
  • Fax:
Mailing address:
  • Phone: 347-753-3412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMARIE JONES
Title or Position: FOUNDER
Credential: B.A.
Phone: 917-903-5131