Healthcare Provider Details

I. General information

NPI: 1326865783
Provider Name (Legal Business Name): NADI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E LAUREL RD
STRATFORD NJ
08084-1324
US

IV. Provider business mailing address

121 E LAUREL RD
STRATFORD NJ
08084-1324
US

V. Phone/Fax

Practice location:
  • Phone: 201-562-3603
  • Fax:
Mailing address:
  • Phone: 201-562-3603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID F. LO
Title or Position: CFO
Credential:
Phone: 201-562-3603