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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ERICA SUSAN GOODMAN RN (RN MANAGER)
(201) 621-3372
Entity
Organization

Contact information

Practice address
235 TERRACE LAKE DR, BUTLER, NJ 07405-3253
(201) 621-3372
(973) 850-6005
Mailing address
235 TERRACE LAKE DR, BUTLER, NJ 07405-3253
(201) 621-3372
(973) 850-6005

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
26NO11190600
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
A4960316
OXFORD
NJ
Enumeration date
06/25/2014
Last updated
06/25/2014
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