Healthcare Provider Details

I. General information

NPI: 1427754738
Provider Name (Legal Business Name): CREATING OPPORTUNITIES FOR YOUTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WOODBRIDGE AVE
SEWAREN NJ
07077-1423
US

IV. Provider business mailing address

17 WOODBRIDGE AVE
SEWAREN NJ
07077-1423
US

V. Phone/Fax

Practice location:
  • Phone: 732-634-2397
  • Fax:
Mailing address:
  • Phone: 732-762-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NGOZI MARTIN-OGUIKE
Title or Position: EXECUTIVE DIRECTOR
Credential: LDT-C
Phone: 732-762-0439