Provider Demographics
NPI:1235266396
Name:SUPREME CONSULTANTS LLC
Entity Type:Organization
Organization Name:SUPREME CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:H.
Authorized Official - Middle Name:GUSTAVO
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:1201-372-9600
Mailing Address - Street 1:298 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1929
Mailing Address - Country:US
Mailing Address - Phone:201-372-9600
Mailing Address - Fax:201-372-9550
Practice Address - Street 1:298 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1929
Practice Address - Country:US
Practice Address - Phone:201-372-9600
Practice Address - Fax:201-372-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0020524Medicaid