Individual
GASTON ACHIDI BOMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2201 S CLINTON AVE STE 2F, SOUTH PLAINFIELD, NJ 07080-1473
(908) 462-4361
Mailing address
2201 S CLINTON AVE STE 2F, SOUTH PLAINFIELD, NJ 07080-1473
(908) 462-4361
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
08/08/2019
Last updated
08/08/2019
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