Healthcare Provider Details

I. General information

NPI: 1659993442
Provider Name (Legal Business Name): NJ MENTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 03/12/2023
Certification Date: 03/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 COTTONTAIL LN STE 330
SOMERSET NJ
08873-1100
US

IV. Provider business mailing address

80 COTTONTAIL LN STE 330
SOMERSET NJ
08873-1100
US

V. Phone/Fax

Practice location:
  • Phone: 732-627-9890
  • Fax:
Mailing address:
  • Phone: 857-205-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRETT IAN COHEN
Title or Position: COO
Credential:
Phone: 800-388-5150