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General NPI Number Information
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NPI Number | 1194354324
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Entity Type | Organization
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Legal Business Name | GENERACE GROUP LLC
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 123 EGG HARBOR RD STE 703
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City | SEWELL
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State | NJ
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Zip | 08080-9410
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Country | US
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Telephone | 608-271-6582
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Fax |
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Provider Business Mailing Address
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Address Line | 123 EGG HARBOR RD STE 703
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City | SEWELL
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State | NJ
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Zip | 08080-9410
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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 | DIRECTOR
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Name | ANDREW ZMUDA
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Credential | PHD
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Telephone | 609-271-6582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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