Provider Demographics
NPI:1457116428
Name:ZELAYA, IRMA CELINE
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:CELINE
Last Name:ZELAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 EMMA ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07201-1910
Mailing Address - Country:US
Mailing Address - Phone:908-368-7391
Mailing Address - Fax:
Practice Address - Street 1:424 CENTRAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2561
Practice Address - Country:US
Practice Address - Phone:737-204-1635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJZ23533676355022106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJYHZ71762365Medicaid