Organization
THE POD SPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMALIA DE MIER (OWNER)
(201) 994-7028
Entity
Organization
Contact information
Practice address
9014 DURHAM AVE, 2ND FLOOR, NORTH BERGEN, NJ 07047-4438
(201) 988-7058
Mailing address
7000 BOULEVARD EAST, GUTTENBERG, NJ 07093-4818
(201) 988-7058
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
25MA03452100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0470406
—
NJ
Enumeration date
09/11/2014
Last updated
09/19/2014
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