Organization
EDI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JUDY WILSON (OPERATOR)
(973) 885-0206
Entity
Organization
Contact information
Practice address
36 NEWARK WAY, SUITE 202, MAPLEWOOD, NJ 07040-3310
(973) 885-0206
(973) 761-6624
Mailing address
PO BOX 301, SOUTH ORANGE, NJ 07079-0301
(973) 885-0206
(973) 761-6624
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NJ
332U00000X
Home Delivered Meals
Primary
—
NJ
Other
Enumeration date
08/05/2008
Last updated
08/05/2008
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