Organization
SUPPORTIVE CARE OF ILLINOIS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOV NEWMARK (CEO)
(718) 298-2753
Entity
Organization
Contact information
Practice address
410 N 2ND ST, MARSHALL, IL 62441-1010
(866) 708-1240
Mailing address
27 RANDOLPH RD, HOWELL, NJ 07731-8611
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
02/09/2023
Last updated
02/09/2023
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