Provider Demographics
NPI:1962000166
Name:ONYX DIRECT CARE LLC
Entity Type:Organization
Organization Name:ONYX DIRECT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:617-817-0456
Mailing Address - Street 1:470 PROSPECT AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4106
Mailing Address - Country:US
Mailing Address - Phone:973-520-0302
Mailing Address - Fax:
Practice Address - Street 1:470 PROSPECT AVE STE 302
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4106
Practice Address - Country:US
Practice Address - Phone:973-520-0302
Practice Address - Fax:973-306-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty