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General NPI Number Information
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NPI Number | 1699649806
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Entity Type | Organization
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Legal Business Name | ETERRA HEALTH PC
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 158 LINWOOD PLZ STE 307
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City | FORT LEE
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State | NJ
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Zip | 07024-3761
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Country | US
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Telephone | 848-305-9934
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Fax | 432-277-8130
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Provider Business Mailing Address
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Address Line | 45 E EDSALL AVE # 1
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City | PALISADES PARK
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State | NJ
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Zip | 07650-1420
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Country | US
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Telephone | 848-305-9934
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Fax | 432-277-8130
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Authorized Official
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Title or Position | OWNER
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Name | HYERIM JEON
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Credential | PMHNP
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Telephone | 347-403-4254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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