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General NPI Number Information
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NPI Number | 1346864212
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Entity Type | Organization
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Legal Business Name | QUEENSHADE LLC
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 01/12/2025
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Provider Practice Location Address
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Address Line | 1200 CLINTON AVE STE 100C1
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City | IRVINGTON
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State | NJ
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Zip | 07111-2070
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Country | US
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Telephone | 862-576-3281
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Fax |
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Provider Business Mailing Address
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Address Line | 33 RICH ST
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City | IRVINGTON
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State | NJ
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Zip | 07111-2020
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Country | US
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Telephone | 908-656-4387
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. FOLASHADE E ADEBIYI
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Credential | RN
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Telephone | 908-656-4387
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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