Provider Demographics
NPI:1699597625
Name:ADVANCED THERAPEUTIC MODALITIES, LLC
Entity type:Organization
Organization Name:ADVANCED THERAPEUTIC MODALITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ADDESA
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:908-456-0060
Mailing Address - Street 1:666 YORKTOWN PL
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2208
Mailing Address - Country:US
Mailing Address - Phone:908-456-0060
Mailing Address - Fax:
Practice Address - Street 1:61 HUDSON ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6943
Practice Address - Country:US
Practice Address - Phone:908-456-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty