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General NPI Number Information
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NPI Number | 1033061064
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Entity Type | Organization
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Legal Business Name | DIVINT HEALTH
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 11 THOMASINE ST
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City | EDISON
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State | NJ
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Zip | 08817-5221
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Country | US
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Telephone | 347-264-3957
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Fax |
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Provider Business Mailing Address
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Address Line | 11 THOMASINE ST
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City | EDISON
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State | NJ
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Zip | 08817-5221
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Country | US
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Telephone | 347-264-3957
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | VIVIEN OGON
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Credential |
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Telephone | 856-398-0428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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