Provider Demographics
NPI:1043780117
Name:NEIGHBORHOOD FAMILY CLINIC AND COUNSELING CENTER LLC
Entity type:Organization
Organization Name:NEIGHBORHOOD FAMILY CLINIC AND COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALLISTA
Authorized Official - Middle Name:N
Authorized Official - Last Name:IWUALA
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:201-362-9916
Mailing Address - Street 1:46 CRYSTAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3546
Mailing Address - Country:US
Mailing Address - Phone:201-362-9916
Mailing Address - Fax:
Practice Address - Street 1:860 GROVE ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3601
Practice Address - Country:US
Practice Address - Phone:201-362-9916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily