| Avicenna Medical Group, Llc | |
|
414 Eagle Rock Ave Suite 307 West Orange NJ 07052-4224 | |
| (646) 464-3110 | |
| Not Available |
| Full Name | Avicenna Medical Group, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 414 Eagle Rock Ave, West Orange, New Jersey |
| Authorized Official Name and Position | Fadi Samaan (MANAGER) |
| Authorized Official Contact | 6464643110 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avicenna Medical Group, Llc 414 Eagle Rock Ave Suite 307 West Orange NJ 07052-4224 Ph: (646) 464-3110 | Avicenna Medical Group, Llc 414 Eagle Rock Ave Suite 307 West Orange NJ 07052-4224 Ph: (646) 464-3110 |
| NPI Number | 1194067959 |
|---|---|
| Provider Enumeration Date | 03/20/2013 |
| Last Update Date | 03/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194067959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 25MB07627000 (New Jersey) | Primary |
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