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NPI Code Detail

MEDICARE: ESHA CHABRA LAC

MEDICARE: ESHA CHABRA LAC
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
1101YM0800XMental Health Counselor37AC00365200NJ

General Provider Information

NPI Number : 1518432178
Entity Type Code : Individual
Provider Name (Legal Business Name) : ESHA CHABRA LAC
Provider Business Mailing Address
First Line : 2 POINT OF WOODS DR
Second Line :
City : NORTH BRUNSWICK
State : NJ
Zip : 08902-1208
Country : US
Telephone Number : 908-812-0635
Fax Number :
Provider Business Practice Location Address
First Line : 63 MILLTOWN RD
Second Line :
City : EAST BRUNSWICK
State : NJ
Zip : 08816-2378
Country : US
Telephone Number : 732-659-0683
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2018
Last Update Date : 10/10/2018

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