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Organization
MINDSPACE CLINIC
Active
Organization
MINDSPACE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILIAN KORDIE NPA (PROVIDER)
(201) 407-0702
Entity
Organization
Contact information
Practice address
137 EVEGREEN PLACE, SUITE 1B, EAST ORANGE, NJ 07018-2005
(201) 407-0702
Mailing address
137 EVEGREEN PLACE, EAST ORANGE, NJ 07018-2005
(201) 407-0702
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/11/2022
Last updated
08/11/2022
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