South Amboy Health Center LLC

Primary specialty

Methadone ClinicTaxonomy code 261QM2800X

Legal business name

SOUTH AMBOY HEALTH CENTER LLC

Practice address

1 Main St
South Amboy, NJ 08879-1142

Phone

(908) 258-8765

NPI assigned

Jul 14, 2020

Organization subpart

No

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

Authorized official

Name

John Macevoy

Title

Owner

Phone

(973) 809-8279

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Opioid treatment program

Medicare-enrolled since Jul 20, 2021

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1594684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594684800000",
    "number": "1801414024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MAIN ST",
            "city": "SOUTH AMBOY",
            "state": "NJ",
            "postal_code": "088791142",
            "telephone_number": "908-258-8765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MAIN ST",
            "city": "SOUTH AMBOY",
            "state": "NJ",
            "postal_code": "088791142",
            "telephone_number": "908-258-8765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH AMBOY HEALTH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-14",
        "last_updated": "2020-07-14",
        "certification_date": "2020-07-14",
        "status": "A",
        "authorized_official_last_name": "MACEVOY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-809-8279"
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharee N Simmons, NP
• Stephanie Lynn Soos, FNP-C
• Erica Danielle Sosa
• South Amboy Board of Education
• South Amboy Chiropractic Center LLC
• Janine Spoto, PTA
• Strathmore Treatment Associates
• Strathmore Treatment Associates, LLC
• Dana A Stravelli, LPN
• Latonia D Suydam, CPRS

• Methadone Clinic in South Amboy, NJ
• Providers in South Amboy, NJ by specialty
• Methadone Clinic in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.