| NPI | 1104515865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMIEKA BUGAM Practice Manager 732-307-9644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 163WP0807X Registered Nurse Psychiatric/Mental Health, Child & Adolescent |
| 261QH0100X Clinic/Center Health Service | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2025-02-27 |