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General NPI Number Information
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NPI Number | 1316539745
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Entity Type | Organization
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Legal Business Name | COMMUNITY IMPROVEMENT HEALTH OUTREACH
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 12 MONTCLAIR AVE
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City | PATERSON
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State | NJ
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Zip | 07503-2418
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Country | US
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Telephone | 862-287-5410
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Fax |
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Provider Business Mailing Address
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Address Line | 12 MONTCLAIR AVE
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City | PATERSON
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State | NJ
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Zip | 07503-2418
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Country | US
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Telephone | 862-287-5410
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Fax |
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | TOMICKA S MCMILLION
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Credential | RN,DNP
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Telephone | 862-287-5410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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