=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902898141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE YOUNG MEN'S CHRISTIAN ASSOCIATION OF RED BANK, NJ A NONPROFIT CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2005
-----------------------------------------------------
Last Update Date | 04/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 166 MAPLE AVENUE
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-741-2504
-----------------------------------------------------
Fax | 743-842-3396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 170 PATTERSON AVENUE
-----------------------------------------------------
City | SHREWSBURY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-671-5505
-----------------------------------------------------
Fax | 732-784-6609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | MS. RHONDA ANDERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 732-784-6612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------