Healthcare Provider Details

I. General information

NPI: 1730517343
Provider Name (Legal Business Name): RICHARD MARK OSTROSKY LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ROSEBERRY ST
PHILLIPSBURG NJ
08865-1690
US

IV. Provider business mailing address

185 ROSEBERRY ST
PHILLIPSBURG NJ
08865-1690
US

V. Phone/Fax

Practice location:
  • Phone: 908-859-6784
  • Fax: 908-859-6812
Mailing address:
  • Phone: 908-859-6784
  • Fax: 908-859-6812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL05324700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: