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General NPI Number Information
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NPI Number | 1104061951
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Entity Type | Organization
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Legal Business Name | BE AT EASE
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 1125 ATLANTIC AVE STE 105
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-4806
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Country | US
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Telephone | 609-340-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 ATLANTIC AVE STE 105
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City | ATLANTIC CITY
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State | NJ
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Zip | 08401-4806
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Country | US
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Telephone | 609-340-8200
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Fax |
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Authorized Official
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Title or Position | APN
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Name | CAROLYN M KOSTERA
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Credential | APN
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Telephone | 609-652-3358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 26NJ00102100
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License Number State | NJ
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