Healthcare Provider Details

I. General information

NPI: 1265750269
Provider Name (Legal Business Name): THE NEWSTEAD PROPERTY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 SPEIR DR
SOUTH ORANGE NJ
07079-1049
US

IV. Provider business mailing address

72 SPEIR DR
SOUTH ORANGE NJ
07079-1049
US

V. Phone/Fax

Practice location:
  • Phone: 973-763-3510
  • Fax: 973-763-1421
Mailing address:
  • Phone: 973-763-3510
  • Fax: 973-763-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. CORNELIUS & VERSEY WESLEY MARTIN
Title or Position: PRESIDENT
Credential: M.DIV.
Phone: 973-763-3510