Organization
GREAT MOMENTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IDA JELTOVA PHD (CLINICAL DIRECTOR)
(201) 757-0600
Entity
Organization
Contact information
Practice address
88 W RIDGEWOOD AVE, RIDGEWOOD, NJ 07450-3199
(201) 757-0600
(800) 507-2456
Mailing address
88 W RIDGEWOOD AVE, RIDGEWOOD, NJ 07450-3199
(201) 757-0600
(800) 507-2456
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
10/22/2021
Last updated
11/19/2021
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