Healthcare Provider Details

I. General information

NPI: 1538143102
Provider Name (Legal Business Name): ADVENT CHRISTIAN HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 SOUTH ST SUITE 102
NEW PROVIDENCE NJ
07974-1999
US

IV. Provider business mailing address

301 SICOMAC AVE
WYCKOFF NJ
07481-2159
US

V. Phone/Fax

Practice location:
  • Phone: 908-598-9552
  • Fax: 908-665-9036
Mailing address:
  • Phone: 201-848-5200
  • Fax: 201-848-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN A STAGG
Title or Position: EXECUTIVE VICE PRESIDENT/CFO
Credential:
Phone: 201-848-5200