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General NPI Number Information
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NPI Number | 1467129577
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Entity Type | Organization
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Legal Business Name | ADULT INTEGRATED MEDICAL AND PSYCHIATRIC CARE CONSULT.
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 08/26/2021
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Provider Practice Location Address
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Address Line | 40 UNION AVENUE SUITE 305
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City | IRVINGTON
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State | NJ
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Zip | 07111-3290
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Country | US
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Telephone | 862-955-3234
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Fax | 862-955-3265
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Provider Business Mailing Address
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Address Line | 20 COOLIDGE STREET
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City | IRVINGTON
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State | NJ
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Zip | 07111-1108
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Country | US
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Telephone | 862-955-3234
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Fax | 862-955-3265
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Authorized Official
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Title or Position | ADVANCED PRACTICE NURSE.
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Name | FRANCIS M. BONGAH
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Credential | DNP, APN, MSN
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Telephone | 862-955-3234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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