Individual
TAJE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1075 BROADWAY, PLEASANTVILLE, NY 10570-2346
(914) 491-8723
Mailing address
121 STONY BROOK RD, FISHKILL, NY 12524-2985
(917) 474-6770
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/15/2024
Last updated
10/15/2024
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