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Provider Information for 1568906840


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NELLIE VIAL


Sex: Female

NPI: 1568906840
Last Updated: 2016-12-06
Certification Date:

Details

NameValue
NPI1568906840
Enumeration Date2016-12-06
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 10 BROOK AVE
BASKING RIDGE, NJ 07920-2002
United States

Phone: | Fax:
 
Primary Practice Address 248 COLUMBIA TPKE
SUITE 210
FLORHAM PARK, NJ 07932-1210
United States

Phone: 201-213-0050 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthNJ37PC00567900