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General NPI Number Information
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NPI Number | 1871872226
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Entity Type | Organization
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Legal Business Name | SAMMARET BEHAVIORAL SERVICES PC
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Dates
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Enumeration Date | 08/16/2011
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 225 MILLBURN AVE SUITE 210
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City | MILLBURN
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State | NJ
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Zip | 07041-1737
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Country | US
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Telephone | 973-494-4614
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Fax |
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Provider Business Mailing Address
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Address Line | 52 COMMONWEALTH AVE
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City | NEWARK
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State | NJ
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Zip | 07106-3027
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Country | US
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Telephone | 973-494-4614
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. YETUNDE ADEOLA
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Credential | M.D
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Telephone | 973-494-4614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 25MA08841500
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License Number State | NJ
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