=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275352692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARING EMBODIED MINDS CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2024
-----------------------------------------------------
Last Update Date | 10/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 W NYACK RD APT 71
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-2947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-900-8490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 135 W NYACK RD APT 71
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-2947
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-900-8490
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAWAD MANZOOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-900-8490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------