Organization
DIVINE DEVELOPMENT DISABILITY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAJASSHRI PHADNAIK (MEMBER)
(732) 789-6683
Entity
Organization
Contact information
Practice address
15 CLYDESDALE RD, SCOTCH PLAINS, NJ 07076-2409
(732) 789-6683
Mailing address
15 CLYDESDALE RD, SCOTCH PLAINS, NJ 07076-2409
(732) 789-6683
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
04/03/2023
Last updated
04/03/2023
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