Provider Demographics
NPI:1508409194
Name:SIX PATHS OF HEALTH
Entity Type:Organization
Organization Name:SIX PATHS OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY HEAD
Authorized Official - Prefix:
Authorized Official - First Name:KASAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-609-0207
Mailing Address - Street 1:40 TREMONT TER
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3710
Mailing Address - Country:US
Mailing Address - Phone:973-609-0207
Mailing Address - Fax:
Practice Address - Street 1:40 TREMONT TER
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3710
Practice Address - Country:US
Practice Address - Phone:973-609-0207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty