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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MICHELE MARTINO BENAQUISTA (COMPLIANCE SUPERVISOR)
(973) 521-5757
Entity
Organization

Contact information

Practice address
19 GLORIA LN, FAIRFIELD, NJ 07004-3305
(973) 521-5757
Mailing address
20 JUST RD, FAIRFIELD, NJ 07004-3421
(973) 808-6279

Taxonomy

Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary

Other

Enumeration date
12/01/2023
Last updated
06/04/2024
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