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General NPI Number Information
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NPI Number | 1528636594
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Entity Type | Organization
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Legal Business Name | UBERSTICKS MEDICAL LLC
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 17 MONROE STREET
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City | PASSAIC
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State | NJ
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Zip | 07055-8108
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Country | US
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Telephone | 973-405-8595
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Fax | 973-272-3647
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Provider Business Mailing Address
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Address Line | 4 MONROE ST APT 2A
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City | PASSAIC
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State | NJ
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Zip | 07055-8108
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Country | US
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Telephone | 973-405-8595
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Fax | 973-272-3647
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Authorized Official
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Title or Position | OWNER
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Name | DEYANIRA PENA PLACENCIA
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Credential |
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Telephone | 973-405-8595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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