Healthcare Provider Details

I. General information

NPI: 1184389389
Provider Name (Legal Business Name): RISE GROUP CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LOMBARDY ST STE 110
NEWARK NJ
07102-3210
US

IV. Provider business mailing address

8 LOMBARDY ST STE 110
NEWARK NJ
07102-3210
US

V. Phone/Fax

Practice location:
  • Phone: 201-500-9755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name: SANGEET KHANNA
Title or Position: PROVIDER
Credential: MD
Phone: 347-278-4567