Provider Demographics
NPI:1255159679
Name:STILLED WATERS
Entity type:Organization
Organization Name:STILLED WATERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-247-6441
Mailing Address - Street 1:142 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1504
Mailing Address - Country:US
Mailing Address - Phone:551-247-6441
Mailing Address - Fax:
Practice Address - Street 1:142 IRVING ST
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1504
Practice Address - Country:US
Practice Address - Phone:551-247-6441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management