Organization
MINI MINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MALKA NUSSBAUM BCBA (CLINICAL DIRECTOR)
(732) 886-8113
Entity
Organization
Contact information
Practice address
128 MELVILLE AVE, LAKEWOOD, NJ 08701-4235
(732) 886-8113
Mailing address
128 MELVILLE AVE, LAKEWOOD, NJ 08701-4235
(732) 886-8113
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
04/03/2022
Last updated
06/17/2024
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