Safeway Independent Services, LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SAFEWAY INDEPENDENT SERVICES, LLC

Practice address

130 Village Green LN
Sicklerville, NJ 08081-1641

Phone

(718) 962-4247

NPI assigned

Mar 24, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Russell Shereif Springer

Title

President

Phone

(718) 962-4247

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553385600000",
    "number": "1659831782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 VILLAGE GREEN LN",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080811641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 VILLAGE GREEN LN",
            "city": "SICKLERVILLE",
            "state": "NJ",
            "postal_code": "080811641",
            "telephone_number": "718-962-4247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAFEWAY INDEPENDENT SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-24",
        "last_updated": "2019-03-24",
        "status": "A",
        "authorized_official_last_name": "SPRINGER",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_middle_name": "SHEREIF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-962-4247"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.