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General NPI Number Information
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NPI Number | 1083278949
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Entity Type | Organization
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Legal Business Name | SPISOBOD CONNECTION
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Dates
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Enumeration Date | 04/25/2019
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 270 DAVIDSON AVE
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City | SOMERSET
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State | NJ
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Zip | 08873-4140
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Country | US
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Telephone | 201-650-0438
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6371
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City | SOMERSET
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State | NJ
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Zip | 08875-6371
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | UCHE O' KEEM
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Credential | NP-BC
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Telephone | 201-650-0438
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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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