PROV 205 LLC

BAYONNE, NJ
NPI1063963411
Entity TypeOrganization
Authorized ContactJOEL NUNEZ
Psychologist
201-455-2052
Organization Subpart ?No
Primary Taxonomy103T00000X Psychologist
(Licence: NJ  35SI00437200)
Enumeration Date2016-10-20
Last Update Date2017-04-27
Business Address
PROV 205 LLC
866 BROADWAY SUITE A
BAYONNE, NJ 07002-3070
Phone number: 201-455-2052
Mailing Address
PROV 205 LLC
PO BOX 626
NEW PROVIDENCE, NJ 07974-0626
Phone number: 201-455-2052
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