| Pathway Healthcare LLC | |
|
16 Coolidge Place Hackensack NJ 07601 | |
| (732) 731-9617 | |
| Not Available |
| Full Name | Pathway Healthcare LLC |
|---|---|
| Speciality | Counselor |
| Location | 16 Coolidge Place, Hackensack, New Jersey |
| Authorized Official Name and Position | Olufunke Adebanjo (OWNER) |
| Authorized Official Contact | 4695304932 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathway Healthcare LLC 16 Coolidge Place Hackensack NJ 07601 | Pathway Healthcare LLC 16 Coolidge Place Hackensack NJ 07601 Ph: (732) 731-9617 |
| NPI Number | 1487476644 |
|---|---|
| Provider Enumeration Date | 10/29/2024 |
| Last Update Date | 10/29/2024 |
| Certification Date | 10/25/2024 |
| Medicare PECOS PAC ID | 2365977402 |
|---|---|
| Medicare Enrollment ID | O20241126000776 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487476644 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | () | Primary |
| Provider Name | Alexis Dominguez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487171567 PECOS PAC ID: 9234663386 Enrollment ID: I20241112001306 |
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