Provider Demographics
NPI:1871806059
Name:HOUSECALL PRACTITIONERS, PROFESSIONAL ASSOC
Entity type:Organization
Organization Name:HOUSECALL PRACTITIONERS, PROFESSIONAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SEO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:551-587-3252
Mailing Address - Street 1:22 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1912
Mailing Address - Country:US
Mailing Address - Phone:551-587-3252
Mailing Address - Fax:201-221-8427
Practice Address - Street 1:22 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-1912
Practice Address - Country:US
Practice Address - Phone:551-587-3252
Practice Address - Fax:201-221-8427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-16
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ0014370251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0201049Medicaid