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General NPI Number Information
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NPI Number | 1508596222
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Entity Type | Organization
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Legal Business Name | MAXICARE HEALTHCARE SERVICES INC
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 112 LEHIGH AVE
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City | NEWARK
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State | NJ
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Zip | 07112-2036
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Country | US
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Telephone | 73-409-1406
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Fax |
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Provider Business Mailing Address
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Address Line | 112 LEHIGH AVE
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City | NEWARK
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State | NJ
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Zip | 07112-2036
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Country | US
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Telephone | 73-409-1406
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Fax |
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Authorized Official
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Title or Position | APN
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Name | MR. OLUWATOSIN O OLUNUGA
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Credential |
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Telephone | 973-409-1406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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