Healthcare Provider Details

I. General information

NPI: 1578948121
Provider Name (Legal Business Name): EVEREST UCC WAYNE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 HAMBURG TPKE
WAYNE NJ
07470-2098
US

IV. Provider business mailing address

705 HAMBURG TPKE
WAYNE NJ
07470-2098
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-0000
  • Fax: 253-650-2009
Mailing address:
  • Phone: 973-650-2009
  • Fax: 253-650-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HR MANAGER
Title or Position: MANAGER
Credential:
Phone: 973-777-0000