Healthcare Provider Details

I. General information

NPI: 1154654259
Provider Name (Legal Business Name): COMMUNITIES UNITED HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BROAD ST SUITE EDISON PL.
NEWARK NJ
07102-2760
US

IV. Provider business mailing address

39 CLEREMONT AVE
IRVINGTON NJ
07111-3126
US

V. Phone/Fax

Practice location:
  • Phone: 973-242-5588
  • Fax:
Mailing address:
  • Phone: 862-223-6324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC01301800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number37PC00373000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00426600
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05161500
License Number StateNJ

VIII. Authorized Official

Name: MR. EDWIN E DUNGA
Title or Position: PRESIDENT/CEO
Credential: PHD
Phone: 862-223-6324