Provider Demographics
NPI:1558934893
Name:CINBERG, INDIGO M
Entity Type:Individual
Prefix:
First Name:INDIGO
Middle Name:M
Last Name:CINBERG
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 1:1200 S 5TH ST APT 4135
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-2068
Mailing Address - Country:US
Mailing Address - Phone:862-930-9596
Mailing Address - Fax:
Practice Address - Street 1:1200 S 5TH ST APT 4135
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2068
Practice Address - Country:US
Practice Address - Phone:862-930-9596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC059866001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ83-2885664OtherIRS