Healthcare Provider Details

I. General information

NPI: 1902625007
Provider Name (Legal Business Name): DNA THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 UNION AVE APT C
RUTHERFORD NJ
07070-1563
US

IV. Provider business mailing address

338 UNION AVE APT C
RUTHERFORD NJ
07070-1563
US

V. Phone/Fax

Practice location:
  • Phone: 201-962-6371
  • Fax:
Mailing address:
  • Phone: 201-962-6371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER S PINTO
Title or Position: LPC
Credential: LPC
Phone: 201-962-6371