Provider Demographics
NPI:1104061951
Name:BE AT EASE
Entity type:Organization
Organization Name:BE AT EASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOSTERA
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:609-652-3358
Mailing Address - Street 1:1125 ATLANTIC AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-4806
Mailing Address - Country:US
Mailing Address - Phone:609-340-8200
Mailing Address - Fax:
Practice Address - Street 1:1125 ATLANTIC AVE STE 105
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-4806
Practice Address - Country:US
Practice Address - Phone:609-340-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00102100261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health