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AVICENNA MEDICAL GROUP, LLC
NPI 1194067959
Counselor - Mental Health in West Orange, NJ

Active since March 20, 2013
414 EAGLE ROCK AVE, SUITE 307, WEST ORANGE, NJ 07052(646) 464-3110 Get Directions Write a Review

NPPES record last updated: March 22, 2013. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Avicenna Medical Group, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AVICENNA MEDICAL GROUP, LLC (NPI 1194067959) is a healthcare organization registered as a mental health in West Orange, New Jersey and active in the NPI registry since March 2013. The organization lists Fadi Samaan, Manager, as its authorized official.

NPPES Registry Identity

NPI1194067959
Entity TypeOrganization
Primary Taxonomy101YM0800X
Legal Business NameAVICENNA MEDICAL GROUP, LLC
Location Address414 EAGLE ROCK AVE, SUITE 307West Orange, NJ 07052-4224
Mailing Address414 Eagle Rock Ave, Suite 307West Orange, NJ 07052-4224 · (646) 464-3110
Phone(646) 464-3110
Organization SubpartNo
Authorized OfficialFadi SamaanManager · (646) 464-3110
Enumeration DateMarch 20, 2013
Last NPPES UpdateMarch 22, 2013
✔ NPI 1194067959 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in NJ · 25MB07627000
414 EAGLE ROCK AVE, West Orange, NJ 07052
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. EUGENE MICHAEL STEFANELLI EDS,PHD
Marriage & Family Therapist
414 EAGLE ROCK AVE, SUITE 304
WEST ORANGE, NJ 07052
Essex County (973) 669-0441
MR. JUSTIN TRILLING D.P.T.
Specialist
414 EAGLE ROCK AVE, STE 107
WEST ORANGE, NJ 07052
Essex County (973) 731-7877
JOYCE T O'SHEA APN, CNS
Registered Nurse (Psychiatric/Mental Health)
414 EAGLE ROCK AVE, SUITE 201
WEST ORANGE, NJ 07052
Essex County (973) 395-9160
REBECCA PELLER LPC
Counselor (Mental Health)
414 EAGLE ROCK AVE, SUITE 206
WEST ORANGE, NJ 07052
Essex County (973) 324-2712
DR. GARY A EAGLE O.D.
Optometrist
414 EAGLE ROCK AVE, SUITE 206A
WEST ORANGE, NJ 07052
Essex County (973) 325-0500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Avicenna Medical Group, LLC's NPI number?

The NPI number for Avicenna Medical Group, LLC is 1194067959. It was assigned to this organization in the NPPES registry on March 20, 2013.

Where is Avicenna Medical Group, LLC located?

Avicenna Medical Group, LLC is located at 414 Eagle Rock Ave Suite 307, West Orange, NJ 07052. The listed phone number is (646) 464-3110.

What is Avicenna Medical Group, LLC's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Avicenna Medical Group, LLC was last updated on March 22, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.