| Nj Idtf, Llc | |
|
1005 Rahway Ave Unit 11b Avenel NJ 07001-2066 | |
| (732) 874-5321 | |
| (732) 518-5220 |
| Full Name | Nj Idtf, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1005 Rahway Ave Unit 11b, Avenel, New Jersey |
| Authorized Official Name and Position | Walter Husar (PRESIDENT) |
| Authorized Official Contact | 7328745321 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nj Idtf, Llc 1005 Rahway Ave Unit 11b Avenel NJ 07001-2066 Ph: (732) 874-5321 | Nj Idtf, Llc 1005 Rahway Ave Unit 11b Avenel NJ 07001-2066 Ph: (732) 874-5321 |
| NPI Number | 1578598090 |
|---|---|
| Provider Enumeration Date | 07/12/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 2163440892 |
|---|---|
| Medicare Enrollment ID | O20051110000536 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578598090 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 25MA05323800 (New Jersey) | Primary |
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