Provider Demographics
NPI:1033789789
Name:NU'YU RADIENSE, LLC
Entity Type:Organization
Organization Name:NU'YU RADIENSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARREA
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:856-373-5370
Mailing Address - Street 1:285 S CHURCH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2773
Mailing Address - Country:US
Mailing Address - Phone:856-724-1900
Mailing Address - Fax:856-494-1314
Practice Address - Street 1:285 S CHURCH ST STE 5
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2773
Practice Address - Country:US
Practice Address - Phone:856-724-1900
Practice Address - Fax:856-494-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1457773640Medicaid