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NPI Code Detail

MEDICARE: ACTIVITY AND HUMAN PERFORMANCE CENTER

MEDICARE: ACTIVITY AND HUMAN PERFORMANCE CENTER
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)2138NJ

General Provider Information

NPI Number : 1407181472
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACTIVITY AND HUMAN PERFORMANCE CENTER
Provider Business Mailing Address
First Line : PO BOX 32396
Second Line :
City : NEWARK
State : NJ
Zip : 07102-0796
Country : US
Telephone Number : 973-632-0710
Fax Number : 973-645-9894
Provider Business Practice Location Address
First Line : 95 MARTIN LUTHER KING JR DR
Second Line :
City : JERSEY CITY
State : NJ
Zip : 07305-3025
Country : US
Telephone Number : 201-332-7077
Fax Number : 201-332-7003
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARK H SEGLIN
Credential : PH.D.
Telephone Number : 973-632-0710
Provider Enumeration Date : 10/08/2009
Last Update Date : 10/08/2009

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Directions to “ACTIVITY AND HUMAN PERFORMANCE CENTER ” Practice Location

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