Healthcare Provider Details

I. General information

NPI: 1699560615
Provider Name (Legal Business Name): ETALE AND MEANO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHERBOURG RD
PARSIPPANY NJ
07054-4008
US

IV. Provider business mailing address

42 EAGLE ROCK AVE
ROSELAND NJ
07068-1445
US

V. Phone/Fax

Practice location:
  • Phone: 862-420-4311
  • Fax: 973-228-7068
Mailing address:
  • Phone: 973-652-4541
  • Fax: 973-228-7068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. GWENDOLYN MONANGAI
Title or Position: PRESIDENT
Credential:
Phone: 973-652-4541