Provider Demographics
NPI:1831319631
Name:MY DAUGHTER'S KEEPER, INC
Entity Type:Organization
Organization Name:MY DAUGHTER'S KEEPER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARCELLA
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-565-9313
Mailing Address - Street 1:1086 LIVINGSTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1845
Mailing Address - Country:US
Mailing Address - Phone:732-565-9313
Mailing Address - Fax:732-565-1019
Practice Address - Street 1:1086 LIVINGSTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1845
Practice Address - Country:US
Practice Address - Phone:732-565-9313
Practice Address - Fax:732-565-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0087696Medicaid