=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437644184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARMARK, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2018
-----------------------------------------------------
Last Update Date | 06/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 ROUTE 10 E STE 201
-----------------------------------------------------
City | SUCCASUNNA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07876-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-519-1647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 MARK LN
-----------------------------------------------------
City | SUCCASUNNA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07876-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-519-1647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DARA DURYEA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 973-519-1647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC04409500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------