Provider Demographics
NPI:1508753583
Name:ANG, JANINE
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:ANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 LIONS HEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4050
Mailing Address - Country:US
Mailing Address - Phone:917-892-8077
Mailing Address - Fax:
Practice Address - Street 1:506 HAMBURG TPKE STE 203
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2069
Practice Address - Country:US
Practice Address - Phone:917-892-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07295500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health