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General NPI Number Information
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NPI Number | 1295244572
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Entity Type | Organization
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Legal Business Name | UNITY PLACE OF ATLANTIC COUNTY, LLC
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 09/29/2017
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Provider Practice Location Address
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Address Line | 121 S WHITE HORSE PIKE
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City | HAMMONTON
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State | NJ
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Zip | 08037-1871
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Country | US
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Telephone | 609-704-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 821 WOODLAND DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3038
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Country | US
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Telephone | 347-242-6502
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JERRY TISCHLER
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Credential |
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Telephone | 347-242-6502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | NJ
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