Healthcare Provider Details

I. General information

NPI: 1831319631
Provider Name (Legal Business Name): MY DAUGHTER'S KEEPER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 LIVINGSTON AVE SUITE 2
NORTH BRUNSWICK NJ
08902-1845
US

IV. Provider business mailing address

1086 LIVINGSTON AVE SUITE 2
NORTH BRUNSWICK NJ
08902-1845
US

V. Phone/Fax

Practice location:
  • Phone: 732-565-9313
  • Fax: 732-565-1019
Mailing address:
  • Phone: 732-565-9313
  • Fax: 732-565-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE MARCELLA CLARK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 732-565-9313