Healthcare Provider Details

I. General information

NPI: 1235250077
Provider Name (Legal Business Name): DAVID CUDIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 HOES LN
PISCATAWAY NJ
08854-5627
US

IV. Provider business mailing address

671 HOES LN
PISCATAWAY NJ
08854-5627
US

V. Phone/Fax

Practice location:
  • Phone: 800-969-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00283800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: