Healthcare Provider Details

I. General information

NPI: 1841656568
Provider Name (Legal Business Name): ADELA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 FREEMAN STREET
NEWARK NJ
07105
US

IV. Provider business mailing address

6 ANDREW CT
BLOOMFIELD NJ
07003-3829
US

V. Phone/Fax

Practice location:
  • Phone: 973-596-4190
  • Fax: 973-639-6583
Mailing address:
  • Phone: 973-596-3835
  • Fax: 973-596-3834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: