Provider Demographics
NPI:1942749429
Name:NORTHWEST ESSEX COMMUNITY HEALTHCARE
Entity Type:Organization
Organization Name:NORTHWEST ESSEX COMMUNITY HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-450-3100
Mailing Address - Street 1:570 BELLEVILLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:570 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1308
Practice Address - Country:US
Practice Address - Phone:973-450-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ30202251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0008702Medicaid