Healthcare Provider Details

I. General information

NPI: 1134034697
Provider Name (Legal Business Name): KIESHA LEONA BETTS CPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BRANFORD PL STE 2
NEWARK NJ
07102-2711
US

IV. Provider business mailing address

23 BRANFORD PL STE 2
NEWARK NJ
07102-2711
US

V. Phone/Fax

Practice location:
  • Phone: 973-623-7878
  • Fax: 973-623-6536
Mailing address:
  • Phone: 973-623-7878
  • Fax: 973-623-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number51130
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: