Healthcare Provider Details

I. General information

NPI: 1295571628
Provider Name (Legal Business Name): IN THIS MOMENT RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2024
Last Update Date: 07/04/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ROUTE 73 N STE 104
MARLTON NJ
08053-3422
US

IV. Provider business mailing address

51 SAINT CHARLES ST APT 2
NEWARK NJ
07105-5023
US

V. Phone/Fax

Practice location:
  • Phone: 732-309-3251
  • Fax:
Mailing address:
  • Phone: 732-309-3251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HAJAH JALLOH
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 732-309-3251