Provider Demographics
NPI:1679301147
Name:PELL, HAILEY ROSE
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:ROSE
Last Name:PELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3324
Mailing Address - Country:US
Mailing Address - Phone:201-356-7618
Mailing Address - Fax:
Practice Address - Street 1:163 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1711
Practice Address - Country:US
Practice Address - Phone:973-339-0141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician