MEDICARE: NADIA SPEIGHTS- BENTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	253Z00000X	In Home Supportive Care Agency
3	261QA0600X	Adult Day Care Clinic/Center
4	261QD1600X	Developmental Disabilities Clinic/Center
5	261QM0850X	Adult Mental Health Clinic/Center
6	343900000X	Non-emergency Medical Transport (VAN)
7	347C00000X	Private Vehicle
8	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1346808805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIA SPEIGHTS- BENTON

Provider Business Mailing Address
First Line	:	230 BERKELEY AVE FL 2
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-2527
Country	:	US
Telephone Number	:	973-303-5881
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 BERKELEY AVE FL 2
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-2527
Country	:	US
Telephone Number	:	973-303-5881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	05/30/2019

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