=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033829924
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NESIVOS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2022
-----------------------------------------------------
Last Update Date | 12/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 681 RIVER AVE STE 2C2D
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-5229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-534-7800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 681 RIVER AVE STE 2C2D
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08701-5229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-534-7800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. MOSHE TENDLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-966-4835
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------