=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639692056
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMOS CENTER FOR WELLNESS AND RECOVERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2017
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 773 TEANECK RD
-----------------------------------------------------
City | TEANECK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07666-4846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-817-9962
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3145
-----------------------------------------------------
City | TEANECK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07666-9103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-817-9962
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | MR. ASSAF AMOS
-----------------------------------------------------
Credential | LCSW, LCADC, MSW
-----------------------------------------------------
Telephone | 201-817-9962
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 44SC05730200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------