Healthcare Provider Details

I. General information

NPI: 1871782334
Provider Name (Legal Business Name): CATHOLIC CHARITIES DIOCESE OF METUCHEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ABEEL ST
NEW BRUNSWICK NJ
08901-1303
US

IV. Provider business mailing address

319 MAPLE ST ATTN AVAZQUEZ
PERTH AMBOY NJ
08861-4101
US

V. Phone/Fax

Practice location:
  • Phone: 732-745-9800
  • Fax:
Mailing address:
  • Phone: 732-324-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIO J COTO
Title or Position: ASST EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 732-324-8200