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General NPI Number Information
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NPI Number | 1295246510
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Entity Type | Individual
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Provider Name | FAITH ESSENCE SMASH LMT
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Gender | Female
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 169 PARIS AVE
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City | NORTHVALE
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State | NJ
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Zip | 07647-2028
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Country | US
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Telephone | 201-564-7861
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Fax |
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Provider Business Mailing Address
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Address Line | 169 PARIS AVE
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City | NORTHVALE
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State | NJ
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Zip | 07647-2028
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Country | US
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Telephone | 201-564-7861
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 18KT00649900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 18KT00649900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 18KT00649900
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 18KT00649900
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number | 18KT00649900
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License Number State | NJ
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Taxonomy #6
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 18KT00649900
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License Number State | NJ
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