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General NPI Number Information
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NPI Number | 1417291683
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Entity Type | Organization
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Legal Business Name | SPINA BIFIDA RESOURCE NETWORK
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Dates
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Enumeration Date | 11/12/2012
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 84 PARK AVE SUITE G-106
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City | FLEMINGTON
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State | NJ
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Zip | 08822-1172
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Country | US
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Telephone | 908-782-7475
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Fax |
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Provider Business Mailing Address
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Address Line | 84 PARK AVE SUITE G-106
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City | FLEMINGTON
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State | NJ
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Zip | 08822-1172
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Country | US
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Telephone | 908-782-7475
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERTA KESTENBAUM
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Credential | PHD
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Telephone | 908-782-7475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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