Healthcare Provider Details

I. General information

NPI: 1104197615
Provider Name (Legal Business Name): LEARNINGRX OF SHORT HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2012
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MAIN ST
MILLBURN NJ
07041-1179
US

IV. Provider business mailing address

150 MAIN ST
MILLBURN NJ
07041-1179
US

V. Phone/Fax

Practice location:
  • Phone: 973-376-4646
  • Fax:
Mailing address:
  • Phone: 973-376-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CINDY ZHOU
Title or Position: DIRECTOR
Credential:
Phone: 973-376-4646