Organization
FUNCTIONAL MEDICINE CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATRINA STEVENS (OFFICE SUPERVISOR)
(201) 880-0685
Entity
Organization
Contact information
Practice address
481 HACKENSACK AVE, SUITE 2A, HACKENSACK, NJ 07601-6330
(201) 880-0685
(201) 342-4346
Mailing address
481 HACKENSACK AVE, SUITE 2A, HACKENSACK, NJ 07601-6330
(201) 880-0685
(201) 342-4346
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ00080100
NJ
Other
Enumeration date
03/22/2017
Last updated
03/22/2017
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