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Individual

VIVION LARRY BAMBARA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
101 E GIBBSBORO RD APT 1611, LINDENWOLD, NJ 08021-1923
(346) 262-7732
Mailing address
101 E GIBBSBORO RD APT 1611, LINDENWOLD, NJ 08021-1923
(346) 262-7732

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
261QA0600X
Adult Day Care Clinic/Center
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1649857186
NJ
Enumeration date
03/29/2021
Last updated
01/01/2022
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