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General NPI Number Information
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NPI Number | 1043476088
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Entity Type | Organization
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Legal Business Name | MOSAIC HEALTH
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 01/05/2009
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Provider Practice Location Address
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Address Line | 136 FRANKLIN CORNER RD
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2586
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Country | US
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Telephone | 609-482-3701
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Fax |
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Provider Business Mailing Address
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Address Line | 993 LENOX DR SUITE 200
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City | LAWRENCEVILLE
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State | NJ
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Zip | 08648-2316
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Country | US
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Telephone | 609-482-3701
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JESSICA BOWERS-PEPE
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Credential | DO
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Telephone | 609-482-3701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | NJ
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