MEDICARE: CANDIDE PETIT PHAR

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
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		NJ

General Provider Information

NPI Number	:	1851267611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDIDE PETIT PHAR

Provider Business Mailing Address
First Line	:	514 MILLBURN AVE UNIT 1069
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-2508
Country	:	US
Telephone Number	:	917-495-2450
Fax Number	:

Provider Business Practice Location Address
First Line	:	514 MILLBURN AVE UNIT 1069
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-2508
Country	:	US
Telephone Number	:	917-495-2450
Fax Number	:

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

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/16/2025

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Directions to “ CANDIDE PETIT PHAR ” Practice Location

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