Initia Nova LLC
Specialist in Cherry Hill, NJ. Organization (NPI-2).
NPI number1013461243
StatusActive
Last updated in NPPESAug 4, 2016
Details
- NPI
- 1013461243
- Entity type
- Organization (NPI-2)
- Legal business name
- Initia Nova LLC
- Organization subpart
- No
- Enumeration date
- Aug 4, 2016
- Last updated
- Aug 4, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | – | NJ | Yes |
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | 37F100176500 | NJ |
Practice location
1930 Marlton Pike E Ste H42Cherry Hill, NJ 08003-4104
Phone 856-425-2942
Mailing address
1930 Marlton Pike E Ste H42Cherry Hill, NJ 08003-4104
Phone 856-425-2942
Authorized official
Patrick O Sullivan
Chief Medical Officer
8566258563
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