Provider Demographics
NPI:1881772028
Name:CANDLELIGHTING MEDICAL LLC
Entity type:Organization
Organization Name:CANDLELIGHTING MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CANDLELIGHT
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-414-8865
Mailing Address - Street 1:404 CENTRAL AVENUE
Mailing Address - Street 2:SUITE:1
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017
Mailing Address - Country:US
Mailing Address - Phone:973-414-8865
Mailing Address - Fax:973-672-2608
Practice Address - Street 1:404 CENTRAL AVE
Practice Address - Street 2:SUITE:1
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2529
Practice Address - Country:US
Practice Address - Phone:973-414-8865
Practice Address - Fax:973-672-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06081600173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty