Provider Demographics
NPI:1710586763
Name:SKYLIGHT HEALTH GROUP NEW JERSEY PC
Entity Type:Organization
Organization Name:SKYLIGHT HEALTH GROUP NEW JERSEY PC
Other - Org Name:SKYLIGHT HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCHACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-266-9597
Mailing Address - Street 1:82 HARTWELL ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-3025
Mailing Address - Country:US
Mailing Address - Phone:401-266-9597
Mailing Address - Fax:
Practice Address - Street 1:105 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1703
Practice Address - Country:US
Practice Address - Phone:844-644-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty