| Shelleys Way | |
|
50 Union Ave Ste 804b Irvington NJ 07111-5221 | |
| (862) 438-6121 | |
| Not Available |
| Full Name | Shelleys Way |
|---|---|
| Speciality | Counselor |
| Location | 50 Union Ave Ste 804b, Irvington, New Jersey |
| Authorized Official Name and Position | Shelley Porter (CEO/FOUNDER) |
| Authorized Official Contact | 7324854681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shelleys Way 90 Howard St Ste 2 New Brunswick NJ 08901-3137 Ph: (732) 485-4681 | Shelleys Way 50 Union Ave Ste 804b Irvington NJ 07111-5221 Ph: (862) 438-6121 |
| NPI Number | 1639645179 |
|---|---|
| Provider Enumeration Date | 10/23/2018 |
| Last Update Date | 01/06/2025 |
| Certification Date | 01/06/2025 |
| Medicare PECOS PAC ID | 8123556610 |
|---|---|
| Medicare Enrollment ID | O20250113000054 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639645179 | NPI | - | NPPES |
| 0594628 | Medicaid | NJ | |
| 0987042 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | David Alabi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942645544 PECOS PAC ID: 7719128271 Enrollment ID: I20130920000551 |
| Provider Name | Michael Idowu Ojelade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710279534 PECOS PAC ID: 0941567556 Enrollment ID: I20171206000778 |
| Provider Name | Hearns Paul |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902346810 PECOS PAC ID: 3375072937 Enrollment ID: I20250128000023 |
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