Healthcare Provider Details

I. General information

NPI: 1124979562
Provider Name (Legal Business Name): MARTINE ACANFORA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 POWERS DR
PARAMUS NJ
07652-2911
US

IV. Provider business mailing address

386 HARRISON ST
NUTLEY NJ
07110-2517
US

V. Phone/Fax

Practice location:
  • Phone: 973-634-6271
  • Fax:
Mailing address:
  • Phone: 973-634-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number44SL07047200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: